Upper Extremity Neuromuscular Disorders

  • Kenneth R. MeansEmail author
  • Christopher L. Forthman
  • W. Hugh Baugher
  • Ryan D. Katz
  • Raymond A. Wittstadt
  • Keith A. Segalman


Medical caregivers of patients with upper extremity neuromuscular disorders should use a multidisciplinary approach in order to maximize their patients’ function and minimize related adverse events. Nonsurgical treatment options are often trialed initially and typically consist of one or more of the following: limb-specific therapy including stretching and strengthening, functional or hygienic splinting, sensory and/or motor reeducation, and oral or injectable medications. Surgical treatment options can be broadly considered within one or more of the following categories: local nerve repair, grafting, or transfers; local tendon grafting or transfers, free muscle, tendon, and/or nerve flap transfers involving microsurgery; and joint releases, reconstructions, or fusions.


Upper extremity Neuromuscular Nerve palsy Nerve trauma Nerve transfer Tendon transfer Joint fusion 


  1. 1.
    Buckwalter JA, Einhorn TA, Simon SR. Orthopaedic basic science: biology and biomechanics of the musculoskeletal system. 2nd ed. Rosemont: American Academy of Orthopaedic Surgeons; 2000.Google Scholar
  2. 2.
    Jupiter JB, Ring DC. AO Manual of fracture management: hand and wrist. Stuttgart: Thieme; 2005.Google Scholar
  3. 3.
    Means Jr KR, Graham TJ. Disorders of the forearm axis. In: Wolfe SW, Hotchkiss RN, Pederson WC, Kozin SH, editors. Green’s operative hand surgery. 6th ed. Philadelphia: Elsevier; 2011. p. 837–68.CrossRefGoogle Scholar
  4. 4.
    Schütz M, Südkamp NP. Revolution in plate osteosynthesis: new internal fixator systems. J Orthop Sci. 2003;8:252–8.CrossRefPubMedGoogle Scholar
  5. 5.
    Teboul F, Bizot P, Kakkar R, Sedel L. Surgical management of trapezius palsy. J Bone Joint Surg Am. 2004;86-A:1884–90.CrossRefPubMedGoogle Scholar
  6. 6.
    Kozin SH. The evaluation and treatment of children with brachial plexus birth palsy. J Hand Surg Am. 2011;36:1360–9.CrossRefPubMedGoogle Scholar
  7. 7.
    Harryman II DT, Walker ED, Harris SL, Sidles JA, Jackins SE, Matsen III FA. Residual motion and function after glenohumeral or scapulothoracic arthrodesis. J Shoulder Elbow Surg. 1993;2:275–85.CrossRefPubMedGoogle Scholar
  8. 8.
    Anderson KD, Friden J, Lichen RL. Acceptable benefits and risks associated with surgically improving arm function in individuals living with cervical spinal cord injury. Spinal Cord. 2009;47:334–8.CrossRefPubMedGoogle Scholar
  9. 9.
    Mackinnon SE, Novak CB, Myckatyn TM, Tung TH. Results of reinnervation of the biceps and brachialis muscles with a double fascicular transfer for elbow flexion. J Hand Surg Am. 2005;31:183–9.Google Scholar
  10. 10.
    Kozin SH, D’Addesi L, Chafetz RS, Ashworth S, Mulcahey MJ. Biceps-to-Triceps transfer for elbow extension in person with tetraplegia. J Hand Surg. 2010;35A:968–75.CrossRefGoogle Scholar
  11. 11.
    Young JH. Implications of elbow arthrodesis for individuals with paraplegia. Phys Ther. 1993;73:194–201.CrossRefPubMedGoogle Scholar
  12. 12.
    Davidge KM, Yee A, Kahn LC, Mackinnon SE. Median to radial nerve transfers for restoration of wrist, finger, and thumb extension. J Hand Surg Am. 2013;38:1812–27.CrossRefPubMedGoogle Scholar
  13. 13.
    Rayan GM, Young BT. Arthrodesis of the spastic wrist. J Hand Surg Am. 1999;24:944–52.CrossRefPubMedGoogle Scholar
  14. 14.
    Terzis JK, Kostopoulos VK. Free muscle transfer in posttraumatic plexopathies: part III. The hand. Plast Reconstr Surg. 2009;124:1225–36.CrossRefPubMedGoogle Scholar
  15. 15.
    Goldner JL, Koman LA, Gelberman R, Levin S, Goldner RD. Arthrodesis of the metacarpophalangeal joint of the thumb in children and adults. Adjunctive treatment of thumb-in-palm deformity in cerebral palsy. Clin Orthop Relat Res. 1990;253:75–89.Google Scholar
  16. 16.
    Lomita C, Ezaki M, Oishi S. Upper extremity surgery in children with cerebral palsy. J Am Acad Orthop Surg. 2010;18:160–8.CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing Switzerland 2017

Authors and Affiliations

  • Kenneth R. Means
    • 1
    Email author
  • Christopher L. Forthman
    • 1
  • W. Hugh Baugher
    • 1
  • Ryan D. Katz
    • 1
  • Raymond A. Wittstadt
    • 1
  • Keith A. Segalman
    • 1
  1. 1.The Curtis National Hand CenterMedStar Union Memorial HospitalBaltimoreUSA

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