Spasticity Reduction

At Tetrahand Cyprus, we provide expert surgical solutions for spasticity reduction, helping individuals with conditions such as cerebral palsy, stroke, or spinal cord injury achieve better control, comfort, and function in their upper limbs.

Spasticity Reduction Procedures: Hyperselective Neurectomies, Tenotomies, and Tendon Lengthenings

Spasticity is a complex condition that affects many individuals following central nervous system injuries such as cerebral palsy, stroke, traumatic brain injury, or spinal cord injury. Characterized by involuntary muscle stiffness, overactivity, and limited movement, spasticity can lead to severe disability, joint deformity, pain, and difficulty with personal care and daily activities.

At Tetrahand Cyprus, we specialize in advanced surgical procedures for reducing spasticity in the upper limb, focusing particularly on three powerful interventions: hyperselective neurectomies, tenotomies, and tendon lengthenings. These procedures aim to reduce unwanted muscle overactivity, restore a more functional posture, and enhance voluntary movement—significantly improving a patient’s quality of life and independence.

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Understanding Spasticity

Spasticity is caused by a disruption of signals from the brain and spinal cord to the muscles, leading to hyperactivity of reflexes and increased muscle tone. Unlike normal muscle contraction, spasticity is involuntary, often triggered by stimuli such as touch, movement, or stress. Over time, the continuous muscle tightness can result in:

• Joint contractures

• Abnormal limb postures

• Difficulty with hygiene and dressing

• Impaired function of the hand and arm

• Pain and fatigue

While conservative treatments like medication, physical therapy, and botulinum toxin injections may help some patients, others require surgical intervention to achieve lasting improvement.

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Surgical Options for Spasticity Reduction

At Tetrahand Cyprus, we assess each patient individually to determine the best combination of procedures for their unique presentation. We focus on three highly effective surgical techniques:

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1. Hyperselective Neurectomies

Hyperselective neurectomy is a precise surgical procedure that involves identifying and partially severing specific motor nerve branches that contribute to spasticity, while preserving healthy nerve fibers that support voluntary movement.

How it Works:

Using intraoperative nerve stimulation and monitoring, our surgeons map out the branches of the affected peripheral nerves. The overactive fascicles responsible for the spasticity are selectively resected, while the others are left intact. This technique allows us to fine-tune muscle tone, rather than eliminate function entirely.

Ideal For:

• Patients with focal spasticity, particularly in the biceps, pronator teres, wrist flexors, or finger flexors

• Individuals who have some voluntary control but suffer from overactivity that limits function

Benefits:

• Reduces unwanted muscle contractions

• Maintains voluntary control and strength

• Minimally invasive with excellent precision

• Often performed as part of a broader reconstructive plan

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2. Tenotomies

A tenotomy involves surgically cutting a tendon to release a spastic, shortened muscle. This procedure helps restore joint alignment and allows the limb to return to a more neutral, functional position.

How it Works:

The tight or contracted tendon is cut partially or fully, depending on the degree of spasticity and the desired level of correction. In some cases, tendon reattachment may be performed in a lengthened position. Tenotomies are often used in combination with neurectomies to address both the neural and muscular components of spasticity.

Ideal For:

• Severe contractures where muscles have become permanently shortened

• Flexed elbows, clenched fists, pronated forearms, or thumb-in-palm deformities

• Patients who need improved limb positioning for hygiene, dressing, or bracing

Benefits:

• Immediate correction of joint deformity

• Improves passive range of motion

• Enables better use of splints or orthotics

• Enhances patient comfort and caregiver ease

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3. Tendon Lengthenings

Tendon lengthening is a more gradual and controlled version of tenotomy. Rather than cutting the tendon completely, this technique involves making precise incisions to allow the tendon to elongate, relieving the tension caused by spasticity.

How it Works:

The tendon is carefully incised in a zig-zag or step-cut pattern, which allows it to stretch while preserving continuity and strength. In some cases, the muscle belly may also be lengthened (myotenotomy) to optimize results. This procedure is typically used when there’s still some muscle function worth preserving.

Ideal For:

• Functional patients with dynamic spasticity

• Children or adults with cerebral palsy

• Situations where joint mobility is restricted but not fixed

Benefits:

• Preserves muscle integrity and function

• Allows for more gradual, natural correction

• Improves the effectiveness of post-surgical therapy

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Comprehensive Approach at Tetrahand Cyprus

Spasticity surgery is not one-size-fits-all. The choice between neurectomy, tenotomy, and tendon lengthening—or a combination of them—is made after thorough clinical assessment, including:

• Neurological examination

• Range of motion and spasticity grading

• Functional goal setting

• Imaging and electromyography (EMG) where necessary

We work closely with physiotherapists, occupational therapists, and caregivers to set realistic goals and define the best surgical strategy for each individual.

Our procedures are often performed under regional or general anesthesia, typically as day surgery or with a short hospital stay. Most patients begin rehabilitation within a few days, focusing on improving range of motion, voluntary control, and functional use of the limb.

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Post-Surgical Rehabilitation

Rehabilitation is essential for maintaining surgical gains and achieving long-term improvements. Post-operative care includes:

• Gentle stretching and splinting

• Functional re-training for tasks like grasping or reaching

• Strengthening of preserved voluntary muscles

• Preventive therapy to avoid re-contracture

With the support of our multidisciplinary team, patients often begin to see improvements within weeks, with continued gains in comfort, positioning, and independence over several months.

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Expected Outcomes

Our experience shows that spasticity reduction surgery can dramatically improve upper limb use and quality of life. Commonly reported benefits include:

• Improved hygiene and dressing ability

• Reduced caregiver burden

• Enhanced comfort and sleep

• Better positioning for bracing or wheelchair use

• Restoration of function in patients with residual motor control

In many cases, these surgeries reduce or eliminate the need for repeated botulinum toxin injections or oral antispasticity medications.

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Why Tetrahand Cyprus?

As a leading center for upper limb reconstruction, Tetrahand Cyprus offers advanced spasticity surgery grounded in global expertise and compassionate care. Our collaboration between Professor Jan Fridén and Dr. Constantinos Kritiotis combines decades of experience in treating complex neurological and orthopedic conditions.

We are one of the few specialized centers in Europe offering hyperselective neurectomy as part of a broader, integrated approach to spasticity management.

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Conclusion

Spasticity can be a life-limiting condition, but with the right surgical approach, patients can achieve remarkable improvements in comfort, appearance, and function. Through techniques like hyperselective neurectomies, tenotomies, and tendon lengthenings, Tetrahand Cyprus helps patients unlock new possibilities—enabling a more mobile, independent, and fulfilling life.

If you or a loved one are struggling with upper limb spasticity, our team is here to help.