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Orthopedic Interventions for the Management of Limb Deformities in Upper Motoneuron Syndromes

  • Chapter
Clinical Evaluation and Management of Spasticity

Part of the book series: Current Clinical Neurology ((CCNEU))

Abstract

Neuro-orthopedics is the field of orthopedic surgery that treats limb deformities resulting from neurologic disease or injury. In this chapter we present the neuro-orthopedic perspective on managing patients with upper motor neuron (UMN) dysfunction. UMN dysfunction commonly follows injuries to the brain from stroke, traumatic brain injury, anoxia, infections of the brain, and perinatal trauma (i.e., cerebral palsy [CP]or static encephalopathy) (1–5). The approach to management of limb dysfunction follows the same principles regardless of etiology. A number of common patterns of movement dysfunction are seen in patients with UMN dysfunction (see Table 1). These patterns typically develop against a background of weakness, impaired voluntary and postural motor control, spasticity, and contracture that comes with the territory of UMN dysfunction.

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References

  1. Keenan, M. A. (1996) Stroke, in Orthopaedic Knowledge Update 5 ( Kasser J.R., ed.), American Academy of Orthopaedic Surgeons, Rosemont, IL, p. 689.

    Google Scholar 

  2. Keenan, M. A. E. (1996) Rehabilitation of the neurologically disabled patient, in Neurosurgery, Vol. (Wilkens, Rhar, S. S, ed.), McGraw-Hill Publishers, New York, NY, p. 445–457.

    Google Scholar 

  3. Mayer, N., Esquenazi, A., and Wannstedt, G. (1996) Surgical planning for upper motoneuron dysfunction: the role of motor control evaluation. J. Head Trauma Rehabil. 11, 37–58.

    Article  Google Scholar 

  4. Perry, J. and Keenan, M. A. E. (1989) Rehabilitation of the neurologically disabled patient, in Neurology and General Medicine,(Aminoff, M. J., ed.), Churchill Livingstone Publishers, New York, p. 747–778.

    Google Scholar 

  5. Mayer, N. H., Esquenazi, A., and Keenan, M. A. E. (1996) Analysis and management of spasticity, contracture, and impaired motor control, in Medical Rehabilitation of Traumatic Brain Injury, ( Horn L. J. and Zasler N. D., eds.), Hanley & Belfus, Inc., Philadelphia, p. 411–458.

    Google Scholar 

  6. Ayers, D. C., Pellegrini, V. D., and Evarts, C.M. (1991) Prevention of hetero-topic ossification in high-risk patients by radiation therapy. Clin. Orthop. 263, 87–93.

    PubMed  Google Scholar 

  7. Beck, E. R. and Bell, K.R. (1995) Deep venous thrombosis in the spastic upper limb. Brain Inj. 9, 413–416.

    Article  PubMed  CAS  Google Scholar 

  8. Beredjiklian, P. K., Iannotti, J. P., Norris, T. R., and Williams, G.R. (1998) Operative treatment of malunion of a fracture of the proximal aspect of the humerus [In Process Citation]. J. Bone Joint Surg [Am.] 80, 1484–1487.

    PubMed  CAS  Google Scholar 

  9. Bidner, S. M., Rubins, I. M., Desjardins, J. V., Zukor, D. J., and Goltzman, D. (1990) Evidence for a humoral mechanism for enhanced osteogenesis after head injury. J. Bone Joint Surg. [Am.] 72, 1144.

    PubMed  CAS  Google Scholar 

  10. Bontke, C. F. and Cobble, N. D. (1991) Rehabilitation in brain disorders. Clinical manifestations and medical issues. Arch Phys Med Rehabil. 72, S320 — S313.

    PubMed  CAS  Google Scholar 

  11. Bontke, C. F. and Cobble, N.D. (1991) Rehabilitation in brain disorders. Clinical manifestations and medical issues. Arch Phys Med Rehabil. 72, S320.

    PubMed  CAS  Google Scholar 

  12. Booth, B. J., Doyle, M., and Montgomery, J. (1960,1983) Serial casting for the management of spasticity in the head injured adult. Phys. Ther. 63, 1960–1966.

    Google Scholar 

  13. Botte, M. J., Keenan, M. A., Abrams, R. A., von Schroeder, H. P., Gellman, H., and Mooney, V. (1997) Heterotopic ossification in neuromuscular disorders. Orthopedics 20, 335.

    PubMed  CAS  Google Scholar 

  14. Botte, M. J., Keenan, M. A. E., and Gelberman, R.H. (1998) Volkmann’s ischemic contracture of the upper extremity. Hand Clin. 14, 483–497.

    PubMed  CAS  Google Scholar 

  15. Botte, M. J., Nickel, V. L., and Akeson, W. H. (1988) Spasticity and contracture. Clin. Orthop. 233, 7–18.

    PubMed  Google Scholar 

  16. Botte, M. J., Nickel, V. L., and Akeson, W. H. (1988) Spasticity and contracture. Clin. Orthop. 233, 7–18.

    PubMed  Google Scholar 

  17. Braun, R. M., West, F., Mooney, V., Nickel, V. L., Roper, B., and Caldwell, C. (1971) Surgical treatment of the painful shoulder contracture in the stroke patient. J. Bone Joint Surg [Am]. 53, 1307–1312.

    PubMed  CAS  Google Scholar 

  18. Braun, R. M., West, F., Mooney, V., Nickel, V. L., Roper, B., and Caldwell, C. (1971) Surgical treatment of the painful shoulder contracture in the stroke patient. J. Bone Joint Surg [Am]. 53, 1307–1312.

    PubMed  CAS  Google Scholar 

  19. Charnley, G., Judet, T., de Loubresse, C. G., and Piriou, P. (1996) Articulated radial head replacement and elbow release for post head-injury heterotopic ossification. J. Orthop. Trauma 10, 68.

    Article  PubMed  CAS  Google Scholar 

  20. Chua, H. C., Tan, C. B., and Tjia, H. (1997) A case of bilateral ulnar nerve palsy in a patient with traumatic brain injury and heterotopic ossification. Singapore Med. J. 38, 447, 448.

    Google Scholar 

  21. Citta-Pietrolungo, T. J., Alexander, M. A., and Steg, N.L. (1992) Early detection of heterotopic ossification in young patients with traumatic brain injury. Arch. Phys. Med. Rehabil. 73, 258–262.

    PubMed  CAS  Google Scholar 

  22. Cosgrove, J. L., Vargo, M., and Reidy, M.E. (1989) A prospective study of peripheral nerve lesions occurring in traumatic brain-injured patients [see comments]. Am. J. Phys. Med. Rehabil. 68, 15–17.

    Article  PubMed  CAS  Google Scholar 

  23. Fitzsimmons, A. S., O’Dell, M. W., Guiffra, L. J., and Sandel, M.E. (1993) Radial nerve injury associated with traumatic myositis ossificans in a brain injured patient. Arch. Phys. Med. Rehabil. 74, 770–773.

    Article  PubMed  CAS  Google Scholar 

  24. Frischhut, B., Stockhammer, G., Saltuari, L., Kadletz, R., and Bramanti, R (1993) Early removal of periarticular ossifications in patients with head injury. Acta Neurol. (Napoli) 15, 114–122.

    CAS  Google Scholar 

  25. Garland, D. E. (1988) Clinical observations on fractures and heterotopic ossification in the spinal cord and traumatic brain injured populations. Clin. Orthop. 233, 86–101.

    PubMed  Google Scholar 

  26. Garland, D. E. (1991) A clinical perspective on common forms of acquired heterotopic ossification. Clin. Orthop. 13–29.

    Google Scholar 

  27. Garland, D. E. (1991) Surgical approaches for resection of heterotopic ossification in traumatic brain-injured adults. Clin. Orthop. 59–70.

    Google Scholar 

  28. Garland, D. E. (1992) Evidence for a humoral mechanism for enhanced osteogenesis after head injury [letter; comment]. J. Bone Joint Surg. [Am]. 74, 152, 153.

    Google Scholar 

  29. Garland, D., Alday, B., and Venos, K. (1984) Heterotopic ossification and HLA antigens. Arch. Phys. Med. Rehabil. 65, 531, 532.

    Google Scholar 

  30. Garland, D. E., Blum, C. E., and Waters, R. L. (1980) Periarticular heterotopic ossification in head-injured adults. Incidence and location. J. Bone Joint Surg. [Am]. 62, 1143–1146.

    PubMed  CAS  Google Scholar 

  31. Garland, D. E., Hanscom, D. A., Keenan, M. A., Smith, C., and Moore, T. (1985) Resection of heterotopic ossification in the adult with head trauma. J. Bone Joint Surg. [Am]. 67, 1261–1269.

    PubMed  CAS  Google Scholar 

  32. Garland, D. E., Keenan, M. A. (1983) Orthopedic strategies in the management of the adult head-injured patient. Phys. Ther. 63, 2004–2009.

    PubMed  CAS  Google Scholar 

  33. Gennarelli, T. A. (1988) Heterotopic ossification. Brain Inf. 2, 175–178.

    Article  CAS  Google Scholar 

  34. Hurvitz, E. A., Mandac, B. R., Davidoff, G., Johnson, J. H., and Nelson, V.S. (1992) Risk factors for heterotopic ossification in children and adolescents with severe traumatic brain injury. Arch. Phys. Med. Rehabil. 73, 459–462.

    PubMed  CAS  Google Scholar 

  35. Keenan, M. A. (1988) Management of the spastic upper extremity in the neurologically impaired adult. Clin. Orthop. 116–125.

    Google Scholar 

  36. Keenan, M. A. and Haider T. (1996) The formation of heterotopic ossification after traumatic brain injury: a biopsy study with ultrastructural analysis. J. Head Trauma Rehabil. 11, 8–22.

    Article  Google Scholar 

  37. Keenan, M. A., Kauffman, D. L., Garland, D. E., and Smith, C. (1988) Late ulnar neuropathy in the brain-injured adult. J. Hand Surg. [Am]. 13, 120–124.

    Article  CAS  Google Scholar 

  38. Keenan, M. E. and Waters, R. L. (1995) Heterotopic ossification, in Diagnosis and Treatment in Orthopedics, ( Skinner H.B., ed.), Prentice Hall, New Jersey, 580–625.

    Google Scholar 

  39. Kolessar, D. J., Katz, S. D., and Keenan, M. E. (1996) Functional outcome following surgical resection of heterotopic ossification in patients with brain injury. J. Head Trauma Rehabil. 4, 78–87.

    Article  Google Scholar 

  40. McAuliffe, J. A., and Wolfson, A. H. (1997) Early excision of heterotopic ossification about the elbow followed by radiation therapy. J. Bone Joint Surg. [Am]. 79, 749.

    PubMed  CAS  Google Scholar 

  41. Meythaler, J. M., Tuel, S. M., Cross, L. L., and Mathew, M. M. (1992) Heterotopic ossification of the extensor tendons in the hand associated with traumatic spinal cord injury. J. Am. Paraplegia Soc. 15, 229.

    PubMed  CAS  Google Scholar 

  42. Mitai, M. A., Garber, J. E., Stinson, J. T. (1987) Ectopic bone formation in children and adolescents with head injuries: its management. J. Pediatr. Orthop. 7, 83–90.

    Article  Google Scholar 

  43. Money, R. A. (1972) Ectopic paraarticular ossification after head injury. Med J. Aust. 1, 125–127.

    PubMed  CAS  Google Scholar 

  44. Moore, J. M. (1993) Functional outcome following surgical excision of heterotopic ossification in patients with traumatic brain injury. J. Orthop. Trauma. 7, 11–14.

    Article  PubMed  CAS  Google Scholar 

  45. Moore, T. J. (1993) Functional outcome following surgical excision of heterotopic ossification in patients with traumatic brain injury. J. Orthop. Trauma. 7, 11–19.

    Article  PubMed  CAS  Google Scholar 

  46. Mysiw, W. J., Tan, J., and Jackson, R. D. (1993) Heterotopic ossification. The utility of osteocalcin in diagnosis and management. Am. J. Phys. Med. Rehabil. 72, 184–187.

    Article  PubMed  CAS  Google Scholar 

  47. O’Dwyer, N. J., Ada, L., and Neilson, P. D. (1996) Spasticity and muscle contracture following stroke. Brain 119, 1737.

    Article  PubMed  Google Scholar 

  48. Otfinowski, J. (1993) Heterotopic induction of osteogenesis in the course of neural injury. Patol. Pol. 44, 133–168.

    PubMed  CAS  Google Scholar 

  49. Ough, J. L., Garland, D. E., Jordan, C., and Waters, R. L. (1981) Treatment of spastic joint contractures in mentally disabled adults. Orthop. Clin. North Am. 12, 143–151.

    CAS  Google Scholar 

  50. Ozaki, J. (1996) Pathomechanics and operative management of chronic frozen shoulder. Ann. Chir. Gynaecol. 85, 156–158.

    PubMed  CAS  Google Scholar 

  51. Perry, J. (1987) Contractures. A historical perspective. Clin. Orthop. 219, 8–14.

    PubMed  Google Scholar 

  52. Pomerance, J. F., Keenan, M. A. (1996) Correction of severe spastic flexion contractures in the nonfunctional hand. J. Hand Surg [Am]. 21, 828–833.

    Article  CAS  Google Scholar 

  53. Ragone, D. J., Jr., Kellerman, W. C., and Bonner, F. J., Jr. (1986) Heterotopic ossification masquerading as deep venous thrombosis in head-injured adult: complications of anticoagulation. Arch. Phys. Med. Rehabil. 67, 339–341.

    PubMed  Google Scholar 

  54. Ritter, M. A. (1987) Indomethacin: an adjunct to surgical excision of immature heterotopic bone formation in a patient with a severe head injury. A case report. Orthopedics 10, 1379–1381.

    PubMed  CAS  Google Scholar 

  55. Rogers, R. C. (1988) Heterotopic calcification in severe head injury: a preventive programme. Brain Inf. 2, 169–173.

    Article  CAS  Google Scholar 

  56. Roper, B. A. (1987) The orthopaedic management of the stroke patient. Clin. Orthop. 78–86.

    Google Scholar 

  57. Schaeffer, M. A. and Sosner, J. (1995) Heterotopic ossification: treatment of established bone with radiation therapy. Arch. Phys. Med. Rehabil. 76, 284–286.

    Article  PubMed  CAS  Google Scholar 

  58. Sobus, K. M., Alexander, M. A., and Harcke, H. T. (1993) Undetected musculoskeletal trauma in children with traumatic brain injury or spinal cord injury. Arch. Phys. Med. Rehabil. 74, 902–904.

    Article  PubMed  CAS  Google Scholar 

  59. Sobus, K. M., Sherman, N., and Alexander, M. A. (1993) Coexistence of deep venous thrombosis and heterotopic ossification in the pediatric patient. Arch. Phys. Med. Rehabil. 74, 547–551.

    Article  PubMed  CAS  Google Scholar 

  60. Soren, A. and Fetto, J. F. (1996) Contracture of the shoulder joint. Arch. Orthop. Trauma Surg. 115, 270–292.

    Article  PubMed  CAS  Google Scholar 

  61. Spencer, R. F. (1991) Heterotopic ossification in a finger following head injury. J. Hand Surg. 16, 217, 218.

    Google Scholar 

  62. Spielman, G., Gennarelli, T. A., and Rogers, C. R. (1983) Disodium etidronate: its role in preventing heterotopic ossification in severe head injury. Arch. Phys. Med. Rehabil. 64, 539–542.

    PubMed  CAS  Google Scholar 

  63. Stone, L. and Keenan, M. A. (1988) Peripheral nerve injuries in the adult with traumatic brain injury. Clin. Orthop. 136–144.

    Google Scholar 

  64. Stone, L. R. and Keenan, M. A. (1992) Deep-venous thrombosis of the upper extremity after traumatic brain injury. Arch. Phys. Med. Rehabil. 73, 486–489.

    PubMed  CAS  Google Scholar 

  65. Summerfield, S. L., DiGiovanni, C., and Weiss, A. P. (1997) Heterotopic ossification of the elbow. J. Shoulder Elbow Surg. 6, 321.

    Article  PubMed  CAS  Google Scholar 

  66. Swanson, A. B. and de Groot Swanson, G. (1989) Evaluation and treatment of the upper extremity in the stroke patient. Hand Clin. 5, 75–96.

    PubMed  CAS  Google Scholar 

  67. Tsur, A., Sazbon, L., and Lotem, M. (1996) Relationship between muscular tone, movement and periarticular new bone formation in postcoma-unaware (PC-U) patients. Brain Inf. 10, 259–262.

    Article  CAS  Google Scholar 

  68. van der Linden, A. J. (1984) Spontaneous regression of neurogenic heterotopic ossification. Int. Orthop. 8, 25–27.

    Article  PubMed  Google Scholar 

  69. Waters, R. L. (1978) Upper extremity surgery in stroke patients. Clin. Orthop. 30–37.

    Google Scholar 

  70. Young, S. and Keenan, M. A. E. (1992) Extremity fractures in the brain-injured patient, in Orthopaedic Rehabilitation, ( Nickel, VL and Botte, MJ, eds.), Churchill Livingstone, New York, p. 401–410.

    Google Scholar 

  71. Garland D. E. and Bailey S. (1981) Undetected injuries in head-injured adults. Clin. Orthop. 155, 162–165.

    PubMed  Google Scholar 

  72. Orcutt, S. A., Kramer, W. G. D., Howard, M. W., Keenan, M. A., Stone, L. R., Waters, R. L., and Gellman, H. (1990) Carpal tunnel syndrome secondary to wrist and finger flexor spasticity. J. Hand Surg. [Am]. 15, 940–944.

    Article  CAS  Google Scholar 

  73. Ouellette, E. A. and Kelly, R. (1996) Compartment syndromes of the hand. J. Bone Joint Surg. [Am.] 78, 1515.

    PubMed  CAS  Google Scholar 

  74. Hisey, M. S. and Keenan, M. A. E. (1998) Orthopedic management of upper extremity dysfunction following stroke or brain injury, in Operative Hand Surgery, vol. 1., ( Green D. P., Hotchkiss R. N., and Pederson W. C., eds.), Churchill Livingstone, New York, p. 287–324.

    Google Scholar 

  75. Keenan, M. A. (1988) Surgical decision making for residual limb deformities following traumatic brain injury. Orthop. Rev. 17, 1185–1192.

    PubMed  CAS  Google Scholar 

  76. Keenan, M. A. and Waters, R. L. (1993) Surgical treatment of the upper extremity after stroke or brain injury, in Operative Orthopaedics, ( Chapman, M., ed.), Lippincott, Philadelphia, p. 1529–1544.

    Google Scholar 

  77. McDaid, P. and Keenan, M. A.: Management of Upper Extremity Dysfunction Following Stroke and Brain Injury. In Chapman’s Orthopaedic Surgery, Chapman, M. W. (ed.), pp. 1809–1854, Lippincott Williams & Wilkins Publishers, Philadelphia, PA, 2001.

    Google Scholar 

  78. Kolessar, D. and Keenan, M. A. E. (1993) Surgical management of upper extremity deformities following traumatic brain injury, in Neurologic and Orthopaedic Sequelae of TBI, vol. 7, ( Stone, L. R., ed.), Hanley & Belfus, Philadelphia, p. 623–636.

    Google Scholar 

  79. Kozin, S. H. and Keenan, M. A. E. (1991) Principles of surgery for adult brain injury. Curr. Orthop. 5, 75–83.

    Article  Google Scholar 

  80. McCulloch, K. L. and Novack, T. A. (1990) Upper extremity functional assessment in traumatically brain-injured patients. J. Head Trauma Rehabil. 4, 1.

    Article  Google Scholar 

  81. Pinzur, M. S. (1993) Dynamic electromyography in functional surgery for upper limb spasticity. Clin. Orthop. 288, 118.

    PubMed  Google Scholar 

  82. Waters, R. L. and Keenan, M. A. (1988) Surgical treatment of the upper extremity after stroke, in Operative Orthopedics, vol. 1, ( Chapman, M., ed.), Lippincott, Philadelphia, p. 1449–1458.

    Google Scholar 

  83. Keenan, M. A., Perry, J., and Jordan, C. (1984) Factors affecting balance and ambulation following stroke. Clin. Orthop. 165.

    Google Scholar 

  84. Keenan, M. A. (1987) The orthopedic management of spasticity. J. Head Trauma Rehabil. 2, 62–71.

    Article  Google Scholar 

  85. Keenan, M. A. and Waters, R. L. (1995) Orthopedic rehabilitation, in Current Diagnosis and Treatment in Orthopaedics, (H. B. S., ed.), Appleton & Lange Medical, Norwalk, p. 580–625.

    Google Scholar 

  86. Keenan, M. A. E. (1994) Aspekte der orthopadischen behandlung der posttraumaticischen zerebralparese, in Die Behandlung Der Infantilen Zerebralparese, ( Niethard, F. U. C., and Doderlein, L., ed.), Georg Thieme Verlag, Stuttgart, New York, 119–125.

    Google Scholar 

  87. Keenan, M. A. E. and Botte, M. J. (1992) Traumatic brain injury, in Orthopaedic Rehabilitation ( Nickel, V. L., Botte, M. J., eds.), Churchill Livingstone, New York, p. 361–370.

    Google Scholar 

  88. Bauman, J. U., Sutherland, D. H., and Hanggi, A. (1979) Intramuscular pressure during walking. An experimental study using the wick catheter technique. Clin. Orthop. 145, 292–299.

    Google Scholar 

  89. Peter, K. S., Hsu, J. D., Keenan, M. A., and Romansky, S.G. (1996) Histology and intramuscular pressure in spastic muscles. J. Head Trauma Rehabil. 11, 1–7.

    Article  Google Scholar 

  90. Chambers, H., Lauer, A., Kaufman, K., Cardelia, J. M., and Sutherland, D. (1998) Prediction of outcome after rectus femoris surgery in cerebral palsy: the cocontraction of the rectus femoris and vastus lateralis. J. Pediatr. Orthop. 18, 703–711.

    PubMed  CAS  Google Scholar 

  91. Drummond, D. S., Rogala, E., and Templeton, J. (1974) Proximal hamstring release for knee flexion and crouched posture in cerebral palsy. J. Bone and Joint Surg. [Am.] 56-A, 1598–1602.

    Google Scholar 

  92. Edwards, P. and Hsu, J. (1993) SPLATT combined with tendo achilles lengthening for spastic equinovarus in adults: results and predictors of surgical outcome. Foot Ankle 14, 335–338.

    Article  PubMed  CAS  Google Scholar 

  93. Etnyre, B., Chambers, C. S., Scarborough, N. H., and Cain, T. E. (1993) Preoperative and postoperative assessment of surgical intervention for equinus gait in children with cerebral palsy. J. Pediatr. Orthop. 13, 24.

    Article  PubMed  CAS  Google Scholar 

  94. Keenan, M. A., Abrams, R. A., Garland, D. E., and Waters, R. L. (1987) Results of fractional lengthening of the finger flexors in adults with upper extremity spasticity. J. Hand Surg. [Am.] 12, 575–581.

    CAS  Google Scholar 

  95. Keenan, M. A., Gorai, A. P., Smith, C. W., and Garland, D. E. (1987) Intrinsic toe flexion deformity following correction of spastic equinovarus deformity in adults. Foot Ankle 7, 333–337.

    Article  PubMed  CAS  Google Scholar 

  96. Keenan, M. A., Korchek, J. I., Botte, M. J., Smith, C. W., and Garland, D. E. (1987) Results of transfer of the flexor digitorum superficialis tendons to the flexor digitorum profundus tendons in adults with acquired spasticity of the hand. J. Bone Joint Surg. [Am.] 69, 1127–1132.

    PubMed  CAS  Google Scholar 

  97. Keenan, M. A., Romanelli, R. R., and Lunsford, B. R. (1989) The use of dynamic electromyography to evaluate motor control in the hands of adults who have spasticity caused by brain injury. J. Bone Joint Surg. [Am.] 71, 120–126.

    PubMed  CAS  Google Scholar 

  98. Keenan, M. A., Ure, K., Smith, C. W., and Jordan, C. (1988) Hamstring release for knee flexion contracture in spastic adults. Clin. Orthop. 221–226.

    Google Scholar 

  99. Koman, L. A., Gelberman, R. H., Toby, E. B., and Poehling, G. G. (1990) Cerebral palsy. Management of the upper extremity. Clin. Orthop. 62–74.

    Google Scholar 

  100. Kozin, S. H., Keenan, M. A. (1993) Using dynamic electromyography to guide surgical treatment of the spastic upper extremity in the brain-injured patient. Clin. Orthop. 109–117.

    Google Scholar 

  101. Laroche, M., Ighilahriz, O., Moulinier, L., Constantin, A., Cantagrel, A., and Mazieres, B. (1998) Adhesive capsulitis of the shoulder: an open study of 40 cases treated by joint distention during arthrography followed by an intraarticular corticosteroid injection and immediate physical therapy. Rev. Rheum. Engl. Ed. 65, 313–319.

    CAS  Google Scholar 

  102. Lawrence, S. J., and Botte, M. J. (1994) Current topic review: management of the adult spastic equinovarus foot deformity. Foot Ankle Int. 15, 340–346.

    Article  PubMed  CAS  Google Scholar 

  103. Matey, I. (1991) Surgery of the spastic thumb-in-palm deformity. J, Hand Surg. [Br.] 16, 127–132.

    Article  Google Scholar 

  104. Moore, T. (1996) Traumatic brain injury, in Orthopedic Knowledge Update 5 (Kasser, J. R., ed.), American Academy of Orthopedic Surgeons, Rosemont, IL, p. 695, 696.

    Google Scholar 

  105. Ogilvie-Harris, D. J., Biggs, D. J., Fitsialos, D. P., and MacKay, M. (1995) The resistant frozen shoulder. Manipulation versus arthroscopic release. Clin. Orthop. 238–248.

    Google Scholar 

  106. Piazza, S. J. and Delp, S. L. (1996) The influence of muscles on knee flexion during the swing phase of gait. J. Biomech. 29, 723–733.

    Article  PubMed  CAS  Google Scholar 

  107. Perry, J., Waters, R. L., and Perrin, T. (1978) Electromyographic analysis of equinovarus following stroke. Clin. Orthop. 47.

    Google Scholar 

  108. Pinzur, M. S. (1996) Carpectomy and fusion in adult-acquired hand spasticity. Orthopedics 19, 675.

    PubMed  CAS  Google Scholar 

  109. Pomerance, J. and Keenan, M. A. (1975) Management of the spastic elbow and forearm, in Disorders of the Upper Extremity,(Herndon, J.,ed.), in press.

    Google Scholar 

  110. American Academy of Orthopedic Surgeons Instructional Course Lectures (1975) Upper extremity management and surgery, vol. 24. C. V. Mosby, St. Louis, MO, p. 51.

    Google Scholar 

  111. Vogt, J. C. (1998) Split anterior tibial transfer for spastic equinovarus foot deformity: retrospective study of 73 operated feet. J. Foot Ankle Surg. 37, 2.

    Article  PubMed  CAS  Google Scholar 

  112. Waters, R. and Montgomery, J. (1974) Lower extremity management of hemiparesis. Clin. Orthop. 0, 133.

    CAS  Google Scholar 

  113. Waters, R. L., Hislop, H. J., Perry, J., and Antonelli, D. (1978) Energetics: application to the study and management of locomotor disabilities. Energy cost of normal and pathologic gait. Orthop. Clin. North. Am. 9, 351.

    PubMed  CAS  Google Scholar 

  114. Waters, R. L., McNeal, D. R., and Clifford, B. (1984) Correction of footdrop in stroke patients via surgically implanted peroneal nerve stimulator. Acta. Orthop. Belg. 50, 285.

    PubMed  CAS  Google Scholar 

  115. Weiss, A. -P. C., Wiedeman, G. P., Jr., Quenzer, D., Hanington, K. R., Hastings, H. I., and Strickland, J. W. (1995) Upper extremity function after wrist arthrodesis. J. Hand Surg. 20A, 818.

    Article  Google Scholar 

  116. Young, S., Keenan, M. A., and Stone, L. R. (1990) The treatment of spastic planovalgus foot deformity in the neurologically impaired adult. Foot Ankle 10, 317.

    Article  PubMed  CAS  Google Scholar 

  117. Zorowitz, R. D, Idank, D., Ikai, T., Hughes, M. B., and Johnston, M. V. (1995) Shoulder subluxation after stroke: a comparison of four supports. Arch. Phys. Med. Rehabil. 76, 763.

    Article  PubMed  CAS  Google Scholar 

  118. Hendricks, H. T., Hageman, G., and van Limbeek, J. (1997) Prediction of recovery from upper extremity paralysis after stroke by measuring evoked potentials. Scand. J. Rehabil. Med. 29, 155.

    PubMed  CAS  Google Scholar 

  119. Keenan, M. A., Haider, T. T., and Stone, L. R. (1990) Dynamic electromyography to assess elbow spasticity. J. Hand Surg. [Am.] 15, 607.

    Article  CAS  Google Scholar 

  120. Keenan, M. A. E. and Perry, J. (1992) Motion analysis: Upper extremity, in, Orthopedic Rehabilitation, (Nickel, V. L., and Botte, M. J., ed.), Churchill Livingstone, New York, p. 243.

    Google Scholar 

  121. Keenan, M. A., R., A., Lazarus, M., and Perry, J. (1996) Selective release of spastic elbow flexors in the patient with brain injury. J. Head Trauma Rehabil. 11, 57.

    Article  Google Scholar 

  122. Esquenazi, A. and Keenan, M. A. (1993) Gait Analysis, in Rehabilitation Medicine: Principles and Practice, ( DeLisa, J. A., ed.), Lippincott, Philadelphia, p. 122.

    Google Scholar 

  123. Hoffer, M. M., Barakat, G., and Koffman, M. (1985) 10-year follow-up of split anterior tibial tendon transfer in cerebral palsied patients with spastic equinovarus deformity. J. Pediatr. Orthop. 5, 432.

    Google Scholar 

  124. Jordan, C. (1988) Current status of functional lower extremity surgery in adult spastic patients. Clin. Orthop. 102.

    Google Scholar 

  125. Keenan, M. A., Creighton, J., Garland, D. E., and Moore, T. (1984) Surgical correction of spastic equinovarus deformity in the adult head trauma patient. Foot Ankle 5, 35.

    Article  PubMed  CAS  Google Scholar 

  126. Keenan, M. A., Gorai, A. P., Smith, C.W., and D. E., G. (1987) Intrinsic toe flexion deformity following correction of spastic equinovarus deformity in adults. Foot & Ankle 7, 333.

    Article  CAS  Google Scholar 

  127. Kerrigan, D. C. and Glenn, M. B. (1994) An illustration of clinical gait laboratory use to improve rehabilitation management. Am. J. Phys. Med. Rehabil. 73, 421.

    Article  PubMed  CAS  Google Scholar 

  128. Lawrence, S. J. and Botte, M. J. (1994) Management of the adult, spastic, equinovarus foot deformity. Foot Ankle Int. 15, 340.

    Article  PubMed  CAS  Google Scholar 

  129. Perry, J. (1992) Gait Analysis. Normal and Pathological Function, Slack Inc., Thorofare.

    Google Scholar 

  130. Perry, J. (1993) Determinants of muscle function in the spastic lower extremity. Clin Orthop. 10.

    Google Scholar 

  131. Perry, J., Giovan, P., Harris, L. J., Montgomery, J., and Azaria, M. (1978) The determinants of muscle action in the hemipareitc lower extremity. Clin. Orthop. 131, 71.

    PubMed  Google Scholar 

  132. Piccioni, L. and Keenan, M. A. (1992) Surgical management of the spastic equinovarus foot deformity. Operative Tech. Orthop. 2, 146.

    Article  Google Scholar 

  133. Pinzur, M. S., Sherman, R., DiMonte-Levine, P., Kett, N., and Trimble, J. (1986) Adult-onset hemiplegia: changes in gait after muscle-balancing procedures to correct the equinus deformity. J. Bone Joint Surg. [Am.] 68, 1249.

    PubMed  CAS  Google Scholar 

  134. Roper, B. A., Willaims, A., and King, J. B. (1978) The surgical treatrment of equinovarus deformity in adults with spasticity. J. Bone Joint Surg. [Br] 60-B, 533.

    Google Scholar 

  135. Waters, R., Rhoades, M., and Montgomery, J. (1975) Improvement of physical function after stroke: surgical and orthotic management. J. Am. Geriatr. Soc. 23, 248.

    PubMed  CAS  Google Scholar 

  136. Waters, R. L., Frazier, J., Garland, D. E., Jordan, C., and Perry, J. (1982) Electromyographic gait analysis before and after operative treatment for hemiplegic equinus and equinovarus deformity. J. Bone Joint Surg. [Am.] 64, 284.

    PubMed  CAS  Google Scholar 

  137. Waters, R. L., Garland, D. E., Perry, J., Habig, T., and Slabaugh, P. (1979) Stiff-legged gait in hemiplegia: surgical correction. J. Bone Joint Surg. [Am.] 61, 927.

    PubMed  CAS  Google Scholar 

  138. Waters, R. L., Perry, J., and Garland, D. (1978) Surgical correction of gait abnormalities following stroke. Clin. Orthop. 54.

    Google Scholar 

  139. Damron, T. A., Breed, A. L., and Cook, T. (1993) Diminished knee flexion after hamstring surgery in cerebral palsy patients: prevalence and severity. J. Pediatr. Orthop. 13, 188.

    PubMed  CAS  Google Scholar 

  140. Esquenazi, A., Keenan, M. A., and Mayer, N. (1995) Evaluacion y manejo de espasticidad, contracturas y disfuncion del control motor. Kinesiologia 42, 60.

    Google Scholar 

  141. Gage, J. R. (1990) Surgical treatment of knee dysfunction in cerebral palsy. Clin. Orthop. 45.

    Google Scholar 

  142. Mazurkiewicz, S. (1974) Evaluation of some elements of gait in patients with a stiff knee. Chir. Narzadow Ruchu. Ortop. Pol. 39, 627.

    PubMed  CAS  Google Scholar 

  143. Miller, F., Cardoso Dias, R., Lipton, G. E., Albarracin, J. R, Dabney, K. W., and Castagno, R (1997) The effect of rectus EMG patterns on the outcome of rectus femoris transfers. J. Pediatr. Orthop. 17, 603.

    PubMed  CAS  Google Scholar 

  144. Ounpuu, M. S., Muik, E., Davis III, R. B., Gage, J. R., and DeLuca, R A. (1993) Rectus femoris surgery in children with cerebral palsy. Part II: A comparison between the effect of transfer and release of the distal rectus femoris on knee motion. J. Pediatr. Orthop. 13, 331.

    Article  PubMed  CAS  Google Scholar 

  145. Perry, J. (1987) Distal rectus femoris transfer. Dey. Med. Child. Neurol. 29, 153.

    Article  CAS  Google Scholar 

  146. Pinzur, M. S. (1996) Surgical correction of lower extremity problems in patients with brain injury. J. Head Trauma Rehabil. 44, 69.

    Article  Google Scholar 

  147. Riley, P. O. and Kerrigan, D. C. (1998) Torque action of two-joint muscles in the swing period of stiff-legged gait: a forward dynamic model analysis [In Process Citation]. J. Biomech. 31, 835.

    Article  PubMed  CAS  Google Scholar 

  148. Smith, C. W. and Levanthal, L. (1987) Surgical management of lower extremity deformities in adult head injured patients. J. Head Trauma Rehabil. 2, 53.

    Article  Google Scholar 

  149. Botte, M. J., Keenan, M. A. E., and Jordan, C. (1992) Stroke, in Orthopedic Rehabilitation, ( Nickel, V. L., and Botte, M. J., eds.), Churchill Livingstone, New York, p. 337.

    Google Scholar 

  150. Botte, M. J. and Keenan, M. A. E. (1991) Brain injury and stroke, in Operative Nerve Repair and Reconstruction, ( Gelberman, R. H., ed.), Lippincott, Philadelphia, p. 14–13.

    Google Scholar 

  151. Sutherland, D. H. and Davids, J. R. (1993) Common gait abnormalities of the knee in cerebral palsy. Clin. Orthop. 139.

    Google Scholar 

  152. Sutherland, D. H., Santi, M., and Abel, M. E. (1990) Treatment of stiff-knee gait in cerebral palsy: a comparison by gait analysis of distal rectus femoris transfer versus proximal rectus release. J. Pediatr. Orthop. 10, 433.

    PubMed  CAS  Google Scholar 

  153. Botte, M. J., Waters, R. L., Keenan, M. A. E., Jordan, C., and Garland, D. E. (1988) Orthopaedic management of the stroke patient: Part I: Pathophysiology, limb deformity, and patient evaluation. Orthop. Rev. 27, 637.

    Google Scholar 

  154. Botte, M. J., Waters, R. L., Keenan, M. A. E., Jordan, C., and Garland, D. E. (1988) Orthopaedic mangement of the stroke patient: Part II: Treating deformities of the upper and lower extremities. Orthop. Rev. 27, 891.

    Google Scholar 

  155. Andersen, N. H., Sojbjerg, J. O., Johannsen, H. V., and Sneppen, O. (1998) Frozen shoulder: arthroscopy and manipulation under general anesthesia and early passive motion. J. Shoulder Elbow Surg. 7, 218.

    Article  PubMed  CAS  Google Scholar 

  156. Gellman, H, Keenan, M. A., Stone, L., Hardy, S. E., Waters, R. L., and Stewart, C. (1992) Reflex sympathetic dystrophy in brain-injured patients. Pain 51, 307.

    Article  PubMed  CAS  Google Scholar 

  157. Grubbs, N. (1993) Frozen shoulder syndrome: a review of literature. J. Orthop. Sports Phys. Ther. 18, 479.

    PubMed  CAS  Google Scholar 

  158. Ikai, T., Tei, K., Yoshida, K., Miyano, S., and Yonemoto, K. (1998) Evaluation and treatment of shoulder subluxation in hemiplegia: relationship between subluxation and pain. Am. J. Phys. Med. Rehabil. 77, 421.

    Article  PubMed  CAS  Google Scholar 

  159. Murninghan, J. P. (1988) Adhesive capsulitis of the shoulder: current concepts and treatment. Orthopedics 2, 152.

    Google Scholar 

  160. Raj, P., Caloodney, A., Janisse, T., and Cannella, J. (1992) Reflex sympathetic dystrophy, in Skeletal Trauma: Fractures, Dislocations, Ligamentous Injuries, vol. 1. ( Browner, B. D., J. J., Levine, A. M., and Trafton, P. G., eds.), W. B. Saunders, Philadelphia, p. 471.

    Google Scholar 

  161. Shaffer, B. (1992) Frozen shoulder: a long term follow-up. J. Bone Joint Surg. [Am.] 74, 738.

    PubMed  CAS  Google Scholar 

  162. Shaffer, B. (1992) Frozen shoulder: a long term follow-up. J. Bone Joint Surg. [Am.] 74, 738.

    PubMed  CAS  Google Scholar 

  163. Kumar, R., Metter, E. J., Mehta, A. J., and Chew, T. (1990) Shoulder pain in hemiplegia. The role of exercise. Am. J. Phys. Med. Rehabil. 69, 205.

    Article  PubMed  CAS  Google Scholar 

  164. Poulin de Courval, L., Barsauskas, A., Berenbaum, B., Dehaut, F., Dussault, R., Fontaine, F. S., et al. (1990) Painful shoulder in the hemiplegic and unilateral neglect. Arch. Phys. Med. Rehabil. 71, 673.

    Google Scholar 

  165. Zorowitz, R. D., Hughes, M. B., Idank, D., Ikai, T., and Johnston, M. V. (1996) Shoulder pain and subluxation after stroke: correlation or coincidence? Am. J. Occup. Ther. 50, 194.

    Article  PubMed  CAS  Google Scholar 

  166. Keenan, M. A. E., Kozin, S. H., and Berlet, A. C. (1993) Manual of Orthopedic Surgery for Spasticity, Raven Press, New York.

    Google Scholar 

  167. Gellman, H., Keenan, M. A., and Botte, M. J. (1996) Recognition and management of upper extremity pain syndromes in the patient with brain injury. J. Head Trauma Rehabil. 11, 23.

    Article  Google Scholar 

  168. Keenan, M. A. E. and Perry, J. (1990) Evaluation of upper extremity motor control in spastic brain-injured patients using dynamic electromyography. J. Head Trauma Rehabil. 5, 13.

    Article  Google Scholar 

  169. Meals, R. A. (1988) Denervation for the treatment of acquired spasticity of the brachioradialis. J. Bone Joint Surg. [Am.] 70, 1081.

    PubMed  CAS  Google Scholar 

  170. Caldwell, C. and Braun, R. M. (1974) Spasticity in the upper extremity. Clin. Orthop. 0, 80.

    CAS  Google Scholar 

  171. Keenan, M. A., Tomas, E. S., Stone, L., and Gersten, L. M. (1990) Percutaneous phenol block of the musculocutaneous nerve to control elbow flexor spasticity. J. Hand Surg [Am.] 15, 340.

    Article  CAS  Google Scholar 

  172. Stotz, S. and Heimkes, B. (1992) Surgical treatment concepts of deformities of the upper extremities in infantile cerebral palsy. Orthopade. 21, 301.

    PubMed  CAS  Google Scholar 

  173. Suso, S., Vicente, P., and Angles, F. (1985) Surgical treatment of the nonfunctional spastic hand. J. Hand Surg. [Br.] 10, 54.

    CAS  Google Scholar 

  174. Pinzur, M. S., Sherman, R. S., and Dimonte-Levine, P. (1977) Triceps spasticity in traumatic hemiplegia: diagnosis and treatment. Arch. Phys. Med. Rehabil. 68, 446.

    Google Scholar 

  175. Botte, M. J., Abrams, R. A., Keenan, M. A. E., and Mooney, V. (1992) Limb rehabilitation in stroke patients. J. Musculoskeletal Med. 9, 66.

    Google Scholar 

  176. Botte, M. J. and Keenan, M. A. (1987) Reconstructive surgery of the upper extremity in the patient with head trauma. J. Head Trauma Rehabil. 2, 34.

    Article  Google Scholar 

  177. Pinzur, M. S. (1991) Flexor origin release and functional prehension in adult spastic hand deformity. J. Hand Surg. [Br.] 16, 133.

    Article  CAS  Google Scholar 

  178. Pinzur, M. S., Wehner, J., Kett, N., and Trilla, M. (1988) Brachioradialis to finger extensor tendon transfer to achieve hand opening in acquired spasticity. J. Hand Surg. [Am.] 13, 549.

    Article  CAS  Google Scholar 

  179. Botte, M. J., Keenan, M. A., Korchek, J. I., and Waters, R. L. (1987) Modified technique for the superficialis-to-profundus transfer in the treatment of adults with spastic clenched fist deformity. J. Hand Surg. [Am.] 12, 639.

    CAS  Google Scholar 

  180. Braun, R. M. and Vise, G. T. (1973) Sublimis-to-profundus tendon transfers in the hemiplegic upper extremity. J. Bone Joint Surg. [Am.] 55, 873.

    Google Scholar 

  181. Keenan, M. A., Todderud, E. P., Henderson, R., and Botte, M. (1987) Management of intrinsic spasticity in the hand with phenol injection or neurectomy of the motor branch of the ulnar nerve. J. Hand Surg. [Am.] 12, 743.

    Google Scholar 

  182. Botte, M. J., Keenan, M. A., Gellman, H., Garland, D. E., and Waters, R. L. (1989) Surgical management of spastic thumb-in-palm deformity in adults with brain injury. J. Hand Surg. [Am.] 14, 174.

    Article  CAS  Google Scholar 

  183. Dahlin, L. B., Komoto-Tufvesson, Y., and Salgeback, S. (1998) Surgery of the spastic hand in cerebral palsy. Improvement in stereognosis and hand function after surgery. J. Hand Surg. [Br] 23, 334.

    Article  CAS  Google Scholar 

  184. Matey, I. (1963) Surgical treatment of spastic “thumb-in-palm” deformity. J. Bone Joint Surg. [Br] 45, 703.

    Google Scholar 

  185. Matey, I. (1991) Surgery of the spastic thumb-in-palm deformity [see comments]. J. Hand Surg. [Br.] 16, 127.

    Article  Google Scholar 

  186. Rayan, G. M. and Saccone, P. G. (1996) Treatment of spastic thumb-in-palm deformity: a modified extensor pollicis longus tendon rerouting. J. Hand Surg. [Am.] 21, 834.

    Article  CAS  Google Scholar 

  187. Sakellarides, H. T., Mital, M. A., Matza, R. A., and Dimakopoulus, P. (1995) Classification and surgical treatment of the thumb-in-palm deformity in cerebral palsy and spastic paralysis. J. Hand Surg. [Am.] 20, 428.

    Article  CAS  Google Scholar 

  188. Silver, C. M., Litchman, H. M., Simon, S. D., and Motamed, M. (1976) Surgical correction of spastic thumb-in-palm deformity. Dey. Med. Child. Neurol. 18, 632.

    Article  CAS  Google Scholar 

  189. House, J. H., Gwathmey, F. W., Fidler, M. O. (1981) A dynamic approach to the thumb-in palm deformity in cerebral palsy. J. Bone Joint Surg. [Am.] 63, 216.

    PubMed  CAS  Google Scholar 

  190. Smith, R. J (1975) Intrinsic muscles of the fingers: function, dysfunction, and surgical reconstruction, in Instructional Course Lectures, vol. 24. (AAOS, ed.), C. V. Mosby, St Louis, p. 200.

    Google Scholar 

  191. Smith, R. J. (1975) Surgical treatment of the claw hand, in Symposium on Tendon Surgery in the Hand (AAOS, ed.), C.V. Mosby, St. Louis, p. 181.

    Google Scholar 

  192. Zancolli, E. A., and Zancolli, E. R. (1983) The infantile spastic hand. Surgical indications and management. J. Hand Surg. [Am.] 5, 766.

    Google Scholar 

  193. Anmuth, C., Esquenazi, A., and Keenan, M. A. E. (1994) Lower extremity surgery for the spastic patient, in: Spasticity, vol. 8. ( Katz, R., ed.), Hanley & Belfus, Philadelphia, p. 547.

    Google Scholar 

  194. De Quervain, I. A., Simon, S. R., Leurgans, S., Pease, W. S., and McAllister, D. (1996) Gait pattern in the early recovery period after stroke. J. Bone and Joint Surg. [Am.] 64-A, 1506.

    Google Scholar 

  195. Guanche, C., and Keenan, M. A. E. (1992) Principles of orthopaedic rehabilitation. Phys. Med. and Rehab. Clin. North A. 3, 417.

    Google Scholar 

  196. Keenan, M. A., Botte, M. J., Hsu, J., Liebenberg, R., and Moore, T. J. (1993) Symposium: orthopaedic management of patients with traumatic brain injuries. Contemp. Orthop. 27, 357.

    Google Scholar 

  197. Lee, G. A. and Keenan, M. A. Management of lower extremity deformities following stroke and brain injury, in Operative Orthopedics (Chapman, M., ed.), Lippincott, Philadelphia, in press.

    Google Scholar 

  198. Perry, J. and Waters, R. L.Orthopedic evaluation and treatment of the stroke patient. Part

    Google Scholar 

  199. Waters, R. L., Clifford, B., and Jordan, C. (1984) Surgical correction of spastic lower extremity deformities. Acta. Orthop. Belg. 50, 172.

    PubMed  CAS  Google Scholar 

  200. Kerrigan, D. C. and Annaswamy, T. M. (1997) The functional significance of spasticity as assessed by gait analysis. J. Head Trauma Rehabil. 12, 29.

    Article  Google Scholar 

  201. Seymour, N., and Sharrard, W. J. W. (1968) Bilateral proximal release of the hamstrings in cerebral palsy. J. Bone Joint Surg. [Br.] 50-B, 274.

    Google Scholar 

  202. Sharps, C. H., Clancy, M., and Steele, H. H. (1984) A long term retrospective study of proximal hamsting release for hamstring contracture in cerebral palsy. J. Pediatr. Orthop. 4, 443.

    Article  PubMed  CAS  Google Scholar 

  203. Waters, R. L., Perry, J., McDaniels, J. M., and House, K. (1974) The relative strength of the hamstrings during hip extension. J. Bone Joint Surg. [Am.] 56, 1592.

    PubMed  CAS  Google Scholar 

  204. Bauman, J. U., Ruetsch, H., and Shurman, K. (1980) Distal hamstring lengthening in cerebral palsy. Int. Orthop. 3, 305.

    Google Scholar 

  205. Grujic, H., and Asparisi, T. (1982) Distal hamstring release in knee flexion deformity. Int. Orthop. 6, 103.

    Article  PubMed  CAS  Google Scholar 

  206. Keenan, M. A. E. and Waters, R. L. (1993) Surgical treatment of the lower extremity after stroke, in Operative Orthopedics, ( Chapman, M., ed.), Lippincott, Philadelphia, p. 34–49.

    Google Scholar 

  207. Keenan, M. A. E., Lee, G. A., Tuckman, A. S., and Esquenazi, A. Improving calf muscle strength in patients with spastic equinovarus deformity by transfer of the long toe flexors to the os calcis. J. Head Trauma Rehabil. in press.

    Google Scholar 

  208. Morita, S., Yamamoto, H., and Furuya, K. (1994) Anterior transfer of the toe flexors for equinovarus deformity due to hemiplegia. J. Bone and Joint Surg. [Br.] 76-B, 447.

    Google Scholar 

  209. Morita, S., Yamamoto, H., and Furuya, K. (1994) Anterior transfer of the toe flexors for equinovarus deformity due to hemiplegia. J. Bone and Joint Surg. [Br.] 76-B, 447.

    Google Scholar 

  210. O’Byrne, J. M., Kennedy, A., Jenkinson, A., and O’Brien, T. M. (1997) Split tibialis posterior tendon transfer in the treatment of spastic equinovarus foot. J. Pediatr. Orthop. 17, 481.

    PubMed  Google Scholar 

  211. Synder, M., Kumar, S. J., and Stecyk, M. D. (1993) Split tibialis posterior tendon transfer and tendo-Achillis lengthening for spastic equinovarus feet. J. Pediatr. Orthop. 13, 20.

    Article  PubMed  CAS  Google Scholar 

  212. Mann, R. A. (1993) Pes Cavus, in Surgery of the Foot and Ankle ( Mann, R A and Coughlin, M., eds.), Mosby, St. Louis, p. 785.

    Google Scholar 

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Authors
  1. Mary Ann E. Keenan
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  2. Patrick J. McDaid
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  1. Springfield Clinic Neuroscience Institute, Springfield, IL, USA

    David A. Gelber MD

  2. Department of Neurology, Wake Forest University School of Medicine, Winston-Salem, NC, USA

    Douglas R. Jeffery MD, PhD

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Keenan, M.A.E., McDaid, P.J. (2002). Orthopedic Interventions for the Management of Limb Deformities in Upper Motoneuron Syndromes. In: Gelber, D.A., Jeffery, D.R. (eds) Clinical Evaluation and Management of Spasticity. Current Clinical Neurology. Humana Press, Totowa, NJ. https://doi.org/10.1007/978-1-59259-092-6_15

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