Management of intrinsic spasticity in the hand with phenol injection or neurectomy of the motor branch of the ulnar nerve.

Thirty-nine adults with acquired spastic disorders who had 21 phenol injections and 21 neurectomies of the motor branch of the ulnar nerve in Guyon's canal for control of intrinsic spasticity in the hand were reviewed. Follow-up averaged 25.8 months for the patients with phenol blocks and 24.3 months for those who had a neurectomy. Intrinsic spasticity was relieved in all hands postoperatively. After the phenol block, which is a temporizing procedure, 13 hands had return of spasticity in 6 months. Eight hands had little or no return of spasticity and required no further treatment. Neurectomy was performed in predominantly nonfunctional hands with severe hygiene problems and with no potential for further neurologic recovery. Hand function was improved in six hands after phenol block and in one hand after neurectomy. Hygiene was improved in all hands after phenol block and in all except one hand after neurectomy. Two wound infections and one wound dehiscence occurred.