Expert consensus on the surgical evaluation and management of upper extremity spasticity in adults

J Hand Surg Eur Vol. 2023 Nov;48(10):986-997. doi: 10.1177/17531934231192843. Epub 2023 Sep 17.


In the last decade there has been incredible interest and advancement in the surgical care of adult patients with upper motor neuron (UMN) injuries. Spasticity represents a prevalent and debilitating feature of UMN syndrome, which can result from cerebral palsy, spinal cord injury, cerebrovascular accident and traumatic or anoxic brain injury. While several diagnostic tools and management strategies have been described for upper limb spasticity, evidence-based practice guidelines do not currently exist due to low patient volume and a paucity of surgeons routinely performing surgeries in UMN syndrome patients. As such, expert consensus may help provide guidance for patients, therapists and clinicians alike. In this article an expert panel was assembled, and the Delphi method was utilized to present diagnostic considerations, define operative indications, discuss surgical treatment modalities and encourage a standard set of outcome measures for patients with upper extremity spasticity.

Keywords: Upper motor neuron syndrome; cerebral palsy; reconstructive surgery; spasticity; stroke.

Publication types

  • Review

MeSH terms

  • Adult
  • Consensus
  • Humans
  • Muscle Spasticity / diagnosis
  • Muscle Spasticity / etiology
  • Muscle Spasticity / surgery
  • Stroke*
  • Upper Extremity* / surgery