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

  • Mary Ann E. Keenan
  • Patrick J. McDaid
Chapter
Part of the Current Clinical Neurology book series (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.

Keywords

Traumatic Brain Injury Heterotopic Ossification Flexor Carpus Radialis Orthopedic Intervention Volitional Control 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

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References

  1. 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. 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. 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.CrossRefGoogle Scholar
  4. 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. 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. 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.PubMedGoogle Scholar
  7. 7.
    Beck, E. R. and Bell, K.R. (1995) Deep venous thrombosis in the spastic upper limb. Brain Inj. 9, 413–416.PubMedCrossRefGoogle Scholar
  8. 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.PubMedGoogle Scholar
  9. 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.PubMedGoogle Scholar
  10. 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.PubMedGoogle Scholar
  11. 11.
    Bontke, C. F. and Cobble, N.D. (1991) Rehabilitation in brain disorders. Clinical manifestations and medical issues. Arch Phys Med Rehabil. 72, S320.PubMedGoogle Scholar
  12. 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. 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.PubMedGoogle Scholar
  14. 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.PubMedGoogle Scholar
  15. 15.
    Botte, M. J., Nickel, V. L., and Akeson, W. H. (1988) Spasticity and contracture. Clin. Orthop. 233, 7–18.PubMedGoogle Scholar
  16. 16.
    Botte, M. J., Nickel, V. L., and Akeson, W. H. (1988) Spasticity and contracture. Clin. Orthop. 233, 7–18.PubMedGoogle Scholar
  17. 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.PubMedGoogle Scholar
  18. 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.PubMedGoogle Scholar
  19. 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.PubMedCrossRefGoogle Scholar
  20. 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. 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.PubMedGoogle Scholar
  22. 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.PubMedCrossRefGoogle Scholar
  23. 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.PubMedCrossRefGoogle Scholar
  24. 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.Google Scholar
  25. 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.PubMedGoogle Scholar
  26. 26.
    Garland, D. E. (1991) A clinical perspective on common forms of acquired heterotopic ossification. Clin. Orthop. 13–29.Google Scholar
  27. 27.
    Garland, D. E. (1991) Surgical approaches for resection of heterotopic ossification in traumatic brain-injured adults. Clin. Orthop. 59–70.Google Scholar
  28. 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. 29.
    Garland, D., Alday, B., and Venos, K. (1984) Heterotopic ossification and HLA antigens. Arch. Phys. Med. Rehabil. 65, 531, 532.Google Scholar
  30. 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.PubMedGoogle Scholar
  31. 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.PubMedGoogle Scholar
  32. 32.
    Garland, D. E., Keenan, M. A. (1983) Orthopedic strategies in the management of the adult head-injured patient. Phys. Ther. 63, 2004–2009.PubMedGoogle Scholar
  33. 33.
    Gennarelli, T. A. (1988) Heterotopic ossification. Brain Inf. 2, 175–178.CrossRefGoogle Scholar
  34. 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.PubMedGoogle Scholar
  35. 35.
    Keenan, M. A. (1988) Management of the spastic upper extremity in the neurologically impaired adult. Clin. Orthop. 116–125.Google Scholar
  36. 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.CrossRefGoogle Scholar
  37. 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.CrossRefGoogle Scholar
  38. 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. 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.CrossRefGoogle Scholar
  40. 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.PubMedGoogle Scholar
  41. 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.PubMedGoogle Scholar
  42. 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.CrossRefGoogle Scholar
  43. 43.
    Money, R. A. (1972) Ectopic paraarticular ossification after head injury. Med J. Aust. 1, 125–127.PubMedGoogle Scholar
  44. 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.PubMedCrossRefGoogle Scholar
  45. 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.PubMedCrossRefGoogle Scholar
  46. 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.PubMedCrossRefGoogle Scholar
  47. 47.
    O’Dwyer, N. J., Ada, L., and Neilson, P. D. (1996) Spasticity and muscle contracture following stroke. Brain 119, 1737.PubMedCrossRefGoogle Scholar
  48. 48.
    Otfinowski, J. (1993) Heterotopic induction of osteogenesis in the course of neural injury. Patol. Pol. 44, 133–168.PubMedGoogle Scholar
  49. 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.Google Scholar
  50. 50.
    Ozaki, J. (1996) Pathomechanics and operative management of chronic frozen shoulder. Ann. Chir. Gynaecol. 85, 156–158.PubMedGoogle Scholar
  51. 51.
    Perry, J. (1987) Contractures. A historical perspective. Clin. Orthop. 219, 8–14.PubMedGoogle Scholar
  52. 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.CrossRefGoogle Scholar
  53. 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.PubMedGoogle Scholar
  54. 55.
    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.PubMedGoogle Scholar
  55. 56.
    Rogers, R. C. (1988) Heterotopic calcification in severe head injury: a preventive programme. Brain Inf. 2, 169–173.CrossRefGoogle Scholar
  56. 57.
    Roper, B. A. (1987) The orthopaedic management of the stroke patient. Clin. Orthop. 78–86.Google Scholar
  57. 58.
    Schaeffer, M. A. and Sosner, J. (1995) Heterotopic ossification: treatment of established bone with radiation therapy. Arch. Phys. Med. Rehabil. 76, 284–286.PubMedCrossRefGoogle Scholar
  58. 59.
    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.PubMedCrossRefGoogle Scholar
  59. 60.
    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.PubMedCrossRefGoogle Scholar
  60. 61.
    Soren, A. and Fetto, J. F. (1996) Contracture of the shoulder joint. Arch. Orthop. Trauma Surg. 115, 270–292.PubMedCrossRefGoogle Scholar
  61. 62.
    Spencer, R. F. (1991) Heterotopic ossification in a finger following head injury. J. Hand Surg. 16, 217, 218.Google Scholar
  62. 63.
    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.PubMedGoogle Scholar
  63. 64.
    Stone, L. and Keenan, M. A. (1988) Peripheral nerve injuries in the adult with traumatic brain injury. Clin. Orthop. 136–144.Google Scholar
  64. 65.
    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.PubMedGoogle Scholar
  65. 66.
    Summerfield, S. L., DiGiovanni, C., and Weiss, A. P. (1997) Heterotopic ossification of the elbow. J. Shoulder Elbow Surg. 6, 321.PubMedCrossRefGoogle Scholar
  66. 67.
    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.PubMedGoogle Scholar
  67. 68.
    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.CrossRefGoogle Scholar
  68. 69.
    van der Linden, A. J. (1984) Spontaneous regression of neurogenic heterotopic ossification. Int. Orthop. 8, 25–27.PubMedCrossRefGoogle Scholar
  69. 70.
    Waters, R. L. (1978) Upper extremity surgery in stroke patients. Clin. Orthop. 30–37.Google Scholar
  70. 71.
    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. 72.
    Garland D. E. and Bailey S. (1981) Undetected injuries in head-injured adults. Clin. Orthop. 155, 162–165.PubMedGoogle Scholar
  72. 73.
    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.CrossRefGoogle Scholar
  73. 74.
    Ouellette, E. A. and Kelly, R. (1996) Compartment syndromes of the hand. J. Bone Joint Surg. [Am.] 78, 1515.PubMedGoogle Scholar
  74. 75.
    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. 76.
    Keenan, M. A. (1988) Surgical decision making for residual limb deformities following traumatic brain injury. Orthop. Rev. 17, 1185–1192.PubMedGoogle Scholar
  76. 77.
    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. 78.
    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. 79.
    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. 80.
    Kozin, S. H. and Keenan, M. A. E. (1991) Principles of surgery for adult brain injury. Curr. Orthop. 5, 75–83.CrossRefGoogle Scholar
  80. 81.
    McCulloch, K. L. and Novack, T. A. (1990) Upper extremity functional assessment in traumatically brain-injured patients. J. Head Trauma Rehabil. 4, 1.CrossRefGoogle Scholar
  81. 82.
    Pinzur, M. S. (1993) Dynamic electromyography in functional surgery for upper limb spasticity. Clin. Orthop. 288, 118.PubMedGoogle Scholar
  82. 83.
    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. 84.
    Keenan, M. A., Perry, J., and Jordan, C. (1984) Factors affecting balance and ambulation following stroke. Clin. Orthop. 165.Google Scholar
  84. 85.
    Keenan, M. A. (1987) The orthopedic management of spasticity. J. Head Trauma Rehabil. 2, 62–71.CrossRefGoogle Scholar
  85. 86.
    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. 87.
    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. 88.
    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. 89.
    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. 90.
    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.CrossRefGoogle Scholar
  90. 91.
    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.PubMedGoogle Scholar
  91. 92.
    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. 93.
    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.PubMedCrossRefGoogle Scholar
  93. 94.
    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.PubMedCrossRefGoogle Scholar
  94. 95.
    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.Google Scholar
  95. 96.
    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.PubMedCrossRefGoogle Scholar
  96. 97.
    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.PubMedGoogle Scholar
  97. 98.
    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.PubMedGoogle Scholar
  98. 99.
    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. 100.
    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. 101.
    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. 102.
    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.Google Scholar
  102. 103.
    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.PubMedCrossRefGoogle Scholar
  103. 104.
    Matey, I. (1991) Surgery of the spastic thumb-in-palm deformity. J, Hand Surg. [Br.] 16, 127–132.CrossRefGoogle Scholar
  104. 105.
    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. 106.
    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. 107.
    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.PubMedCrossRefGoogle Scholar
  107. 108.
    Perry, J., Waters, R. L., and Perrin, T. (1978) Electromyographic analysis of equinovarus following stroke. Clin. Orthop. 47.Google Scholar
  108. 109.
    Pinzur, M. S. (1996) Carpectomy and fusion in adult-acquired hand spasticity. Orthopedics 19, 675.PubMedGoogle Scholar
  109. 110.
    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. 111.
    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. 112.
    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.PubMedCrossRefGoogle Scholar
  112. 113.
    Waters, R. and Montgomery, J. (1974) Lower extremity management of hemiparesis. Clin. Orthop. 0, 133.Google Scholar
  113. 114.
    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.PubMedGoogle Scholar
  114. 115.
    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.PubMedGoogle Scholar
  115. 116.
    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.CrossRefGoogle Scholar
  116. 117.
    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.PubMedCrossRefGoogle Scholar
  117. 118.
    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.PubMedCrossRefGoogle Scholar
  118. 119.
    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.PubMedGoogle Scholar
  119. 120.
    Keenan, M. A., Haider, T. T., and Stone, L. R. (1990) Dynamic electromyography to assess elbow spasticity. J. Hand Surg. [Am.] 15, 607.CrossRefGoogle Scholar
  120. 121.
    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. 122.
    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.CrossRefGoogle Scholar
  122. 123.
    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. 124.
    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. 125.
    Jordan, C. (1988) Current status of functional lower extremity surgery in adult spastic patients. Clin. Orthop. 102.Google Scholar
  125. 126.
    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.PubMedCrossRefGoogle Scholar
  126. 127.
    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.CrossRefGoogle Scholar
  127. 128.
    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.PubMedCrossRefGoogle Scholar
  128. 129.
    Lawrence, S. J. and Botte, M. J. (1994) Management of the adult, spastic, equinovarus foot deformity. Foot Ankle Int. 15, 340.PubMedCrossRefGoogle Scholar
  129. 130.
    Perry, J. (1992) Gait Analysis. Normal and Pathological Function, Slack Inc., Thorofare.Google Scholar
  130. 131.
    Perry, J. (1993) Determinants of muscle function in the spastic lower extremity. Clin Orthop. 10.Google Scholar
  131. 132.
    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.PubMedGoogle Scholar
  132. 133.
    Piccioni, L. and Keenan, M. A. (1992) Surgical management of the spastic equinovarus foot deformity. Operative Tech. Orthop. 2, 146.CrossRefGoogle Scholar
  133. 134.
    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.PubMedGoogle Scholar
  134. 135.
    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. 136.
    Waters, R., Rhoades, M., and Montgomery, J. (1975) Improvement of physical function after stroke: surgical and orthotic management. J. Am. Geriatr. Soc. 23, 248.PubMedGoogle Scholar
  136. 137.
    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.PubMedGoogle Scholar
  137. 138.
    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.PubMedGoogle Scholar
  138. 139.
    Waters, R. L., Perry, J., and Garland, D. (1978) Surgical correction of gait abnormalities following stroke. Clin. Orthop. 54.Google Scholar
  139. 140.
    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.PubMedGoogle Scholar
  140. 141.
    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. 142.
    Gage, J. R. (1990) Surgical treatment of knee dysfunction in cerebral palsy. Clin. Orthop. 45.Google Scholar
  142. 143.
    Mazurkiewicz, S. (1974) Evaluation of some elements of gait in patients with a stiff knee. Chir. Narzadow Ruchu. Ortop. Pol. 39, 627.PubMedGoogle Scholar
  143. 144.
    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.PubMedGoogle Scholar
  144. 145.
    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.PubMedCrossRefGoogle Scholar
  145. 146.
    Perry, J. (1987) Distal rectus femoris transfer. Dey. Med. Child. Neurol. 29, 153.CrossRefGoogle Scholar
  146. 147.
    Pinzur, M. S. (1996) Surgical correction of lower extremity problems in patients with brain injury. J. Head Trauma Rehabil. 44, 69.CrossRefGoogle Scholar
  147. 148.
    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.PubMedCrossRefGoogle Scholar
  148. 149.
    Smith, C. W. and Levanthal, L. (1987) Surgical management of lower extremity deformities in adult head injured patients. J. Head Trauma Rehabil. 2, 53.CrossRefGoogle Scholar
  149. 150.
    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. 151.
    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. 150.
    Sutherland, D. H. and Davids, J. R. (1993) Common gait abnormalities of the knee in cerebral palsy. Clin. Orthop. 139.Google Scholar
  152. 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.PubMedGoogle Scholar
  153. 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. 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. 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.PubMedCrossRefGoogle Scholar
  156. 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.PubMedCrossRefGoogle Scholar
  157. 157.
    Grubbs, N. (1993) Frozen shoulder syndrome: a review of literature. J. Orthop. Sports Phys. Ther. 18, 479.PubMedGoogle Scholar
  158. 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.PubMedCrossRefGoogle Scholar
  159. 159.
    Murninghan, J. P. (1988) Adhesive capsulitis of the shoulder: current concepts and treatment. Orthopedics 2, 152.Google Scholar
  160. 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. 161.
    Shaffer, B. (1992) Frozen shoulder: a long term follow-up. J. Bone Joint Surg. [Am.] 74, 738.PubMedGoogle Scholar
  162. 162.
    Shaffer, B. (1992) Frozen shoulder: a long term follow-up. J. Bone Joint Surg. [Am.] 74, 738.PubMedGoogle Scholar
  163. 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.PubMedCrossRefGoogle Scholar
  164. 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. 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.PubMedCrossRefGoogle Scholar
  166. 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. 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.CrossRefGoogle Scholar
  168. 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.CrossRefGoogle Scholar
  169. 169.
    Meals, R. A. (1988) Denervation for the treatment of acquired spasticity of the brachioradialis. J. Bone Joint Surg. [Am.] 70, 1081.PubMedGoogle Scholar
  170. 170.
    Caldwell, C. and Braun, R. M. (1974) Spasticity in the upper extremity. Clin. Orthop. 0, 80.Google Scholar
  171. 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.CrossRefGoogle Scholar
  172. 172.
    Stotz, S. and Heimkes, B. (1992) Surgical treatment concepts of deformities of the upper extremities in infantile cerebral palsy. Orthopade. 21, 301.PubMedGoogle Scholar
  173. 173.
    Suso, S., Vicente, P., and Angles, F. (1985) Surgical treatment of the nonfunctional spastic hand. J. Hand Surg. [Br.] 10, 54.Google Scholar
  174. 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. 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. 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.CrossRefGoogle Scholar
  177. 177.
    Pinzur, M. S. (1991) Flexor origin release and functional prehension in adult spastic hand deformity. J. Hand Surg. [Br.] 16, 133.CrossRefGoogle Scholar
  178. 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.CrossRefGoogle Scholar
  179. 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.Google Scholar
  180. 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. 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. 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.CrossRefGoogle Scholar
  183. 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.CrossRefGoogle Scholar
  184. 184.
    Matey, I. (1963) Surgical treatment of spastic “thumb-in-palm” deformity. J. Bone Joint Surg. [Br] 45, 703.Google Scholar
  185. 185.
    Matey, I. (1991) Surgery of the spastic thumb-in-palm deformity [see comments]. J. Hand Surg. [Br.] 16, 127.CrossRefGoogle Scholar
  186. 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.CrossRefGoogle Scholar
  187. 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.CrossRefGoogle Scholar
  188. 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.CrossRefGoogle Scholar
  189. 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.PubMedGoogle Scholar
  190. 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. 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. 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. 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. 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. 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. 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. 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. 198.
    Perry, J. and Waters, R. L.Orthopedic evaluation and treatment of the stroke patient. PartGoogle Scholar
  199. 199.
    Waters, R. L., Clifford, B., and Jordan, C. (1984) Surgical correction of spastic lower extremity deformities. Acta. Orthop. Belg. 50, 172.PubMedGoogle Scholar
  200. 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.CrossRefGoogle Scholar
  201. 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. 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.PubMedCrossRefGoogle Scholar
  203. 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.PubMedGoogle Scholar
  204. 204.
    Bauman, J. U., Ruetsch, H., and Shurman, K. (1980) Distal hamstring lengthening in cerebral palsy. Int. Orthop. 3, 305.Google Scholar
  205. 205.
    Grujic, H., and Asparisi, T. (1982) Distal hamstring release in knee flexion deformity. Int. Orthop. 6, 103.PubMedCrossRefGoogle Scholar
  206. 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. 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. 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. 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. 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.PubMedGoogle Scholar
  211. 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.PubMedCrossRefGoogle Scholar
  212. 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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© Springer Science+Business Media New York 2002

Authors and Affiliations

  • Mary Ann E. Keenan
  • Patrick J. McDaid

There are no affiliations available

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