Article

The adult spastic hand, of varying causes, but dominated by vascular hemiplegia
and brain damage, associates motor disorders and problems of tonus. The variety
of forms of brain damage explains the wealth and diversity of the symptoms. These
symptoms, often the most serious along with cognitive disorders, justify the
expression "central neurological hand". Each case is an individual one. The
effect on the hands may be unilateral or bilateral with spasticity involving the
fingers/thumb/wrist. The clinical evaluation leading to a decision tree must take
into account spasticity, retraction and paralysis, for each muscle. When
completed by anesthetic motor blocks, spasticity and/or retraction, damage to
extrinsic and/or intrinsic muscles of the fingers may be differentiated. This
repeated multidisciplinary evaluation makes it possible to distinguish between
"non functional hands", "functional hands" and "potentially functional hands". In
the first instance, surgery can only improve the esthetic aspect or facilitate
nursing. In the second instance, correcting spasticity may improve function. The
treatment of spasticity is based on inhibiting spasticity (by injecting botulinum
toxin or surgical motor hyponeurotisation) and reinforcing the non-spastic
antagonist muscles via tendon transfer or tenodesis. Surgery is indicated to
correct muscular retraction and deformities. The functional indications are
highly selective and their limited results only allow a "supporting hand" to be
constructed at best. The non-functional indications lead to a codified
intervention whose results will greatly improve the management of these patients.
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Langue : FRANCAIS