Department of Orthopaedic Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA 19104, USA.
J Shoulder Elbow Surg. 2011 Jul;20(5):802-6. doi: 10.1016/j.jse.2010.10.023. Epub 2011 Jan 13.
Shoulder adduction and internal rotation contractures commonly develop in patients with spastic hemiplegia after upper motor neuron (UMN) injury. Contractures are often painful, macerate skin, and impair axillary hygiene. We hypothesize that shoulder tenotomies are an effective means of pain relief and passive motion restoration in patients without active upper extremity motor function.
A consecutive series of 36 adults (10 men, 26 women) with spastic hemiplegia from UMN injury, shoulder adduction, and internal rotation contractures, and no active movement, who underwent shoulder tenotomies of the pectoralis major, latissimus dorsi, teres major, and subscapularis were evaluated. Patients were an average age of 52.2 years. Pain, passive motion, and satisfaction were considered preoperatively and postoperatively.
Average follow-up was 14.3 months. Preoperatively, all patients had limited passive motion that interfered with passive functions. Nineteen patients had pain. After surgery, passive extension, flexion, abduction, and external rotation improved from 50%, 27%, 27%, and 1% to 85%, 70%, 66%, and 56%, respectively, compared with the normal contralateral side (P < .001). All patients with preoperative pain had improved pain relief at follow-up, with 18 (95%) being pain-free. Thirty-five (97%) were satisfied with the outcome of surgery, and all patients reported improved axillary hygiene and skin care. Age, gender, etiology, and chronicity of UMN injury were not associated with improvement in motion.
We observed improvements in passive ROM and high patient satisfaction with surgery at early follow-up. Patients who had pain with passive motion preoperatively had significant improvements in pain after shoulder tenotomy.
Shoulder tenotomy to relieve spastic contractures resulting from UMN injury can be an effective means of pain relief and improved passive range of motion in patients without active motor function.
在上运动神经元 (UMN) 损伤后，痉挛性偏瘫患者常出现肩部内收和内旋挛缩。挛缩通常会引起疼痛、溃烂皮肤，并影响腋窝卫生。我们假设对于没有主动上肢运动功能的患者，肩部肌腱切开术是缓解疼痛和恢复被动运动的有效方法。
对连续 36 例UMN 损伤、肩部内收和内旋挛缩且无主动运动的成人痉挛性偏瘫患者进行了肩部切开术，包括胸大肌、背阔肌、大圆肌和肩胛下肌。患者平均年龄为 52.2 岁。术前和术后评估疼痛、被动运动和满意度。
平均随访 14.3 个月。术前所有患者均存在影响被动功能的受限被动运动。19 例患者有疼痛。术后，被动伸展、屈曲、外展和外旋分别从 50%、27%、27%和 1%改善至 85%、70%、66%和 56%，与正常对侧相比（P<.001）。所有术前有疼痛的患者在随访时均有改善的疼痛缓解，18 例（95%）患者无疼痛。35 例（97%）患者对手术结果满意，所有患者均报告改善了腋窝卫生和皮肤护理。年龄、性别、UMN 损伤的病因和慢性程度与运动改善无关。
我们观察到在早期随访中，被动 ROM 有改善，且患者对手术满意度高。术前有被动运动疼痛的患者，肩部肌腱切开术后疼痛明显改善。
UMN 损伤引起的痉挛性挛缩导致的肩部肌腱切开术可以有效缓解疼痛，并改善无主动运动功能患者的被动运动范围。
