The Future of Upper Extremity Spasticity Management.

Surgical management of upper limb spasticity has traditionally tackled the downstream effects at the muscle, tendon, and joint levels. Because this approach does not address the underlying pathologic condition within the nerve, surgical outcomes have been marked by unsatisfactory relapse over time. Future management may focus on reestablishing a normal neuronal impulse pathway to the dysfunctional musculotendinous unit. By severing the faulty γ-neuronal circuit at the C7 level, spasticity may be reduced. Transfer of the contralateral C7 nerve root to the injured C7 nerve root may open the potential for simultaneously restoring extension and improving reach and grasp functions.