In the United States, nearly 730,000 first-ever strokes occur each year, with a survival rate of more than 80 percent. These survivors often experience significant loss of function in the shoulders, arms, and hands. Orthopaedic treatment is a vital part of the recovery process, according to a review article published in the August 2008 issue of the Journal of the American Academy of Orthopaedic Surgeons.

With proper orthopaedic treatment, stroke patients can hope to achieve:
• Reduction in their pain
• A greater range of motion (ROM)
• A more aesthetically pleasing appearance of the deformed limb

According to senior author, Ranjan Gupta, MD, chair of the Department of Orthopaedic Surgery at the University of California-Irvine, the key to achieving the best results for the patient lies in knowing which treatment to use, and when to use it. “Orthopaedic intervention for stroke patients can help to maximize the chances that the affected arm, for example, may still be useful for activities of daily life,” he said. “It is critical for the orthopaedic surgeon to become involved in the management of these patients immediately following the stroke, to ensure the best possible outcome.”

Proper treatment begins with a careful examination of the patient to identify deformities of the shoulder, elbow, forearm, wrist, fingers, and thumb. For example, electromyography, a test which measures muscle response to nerve stimulation, may also be used to evaluate a patient.

During the first six months following a stroke, nonsurgical procedures are used to allow for possible, spontaneous neurologic recovery.

“During this time, patients and families are primarily focused on the cognitive effects of the injury,” Dr. Gupta said. “But it is important to remember that there are numerous non-surgical treatments that should be employed to maximize the functional use of the affected limb.”

Nonsurgical treatments may include but are not limited to:

• Positioning the arm or leg to make the patient more comfortable
• ROM exercises
• Splinting to prevent muscle spasms
• Use of medications to reduce pain and eliminate muscle spasms
• Electrical stimulation to activate nerves

After six months, according to Dr. Gupta, “It becomes crucial to consider surgery to reduce or eliminate painful muscle spasms and correct deformities. The type of surgery performed depends on which areas are affected and whether or not the limb has been determined to be functional”.

According to Dr. Gupta:

• Surgical procedures on patients with nonfunctional arms and legs are often more aggressive, and are primarily performed to address issues of hygiene and to make the patient more comfortable.
• Surgical treatment of functional and non-functional limbs may include release or lengthening of tendons, release of muscles, and removal of nerves
• Following surgery, it is essential for all patients to undergo ROM exercises, to use splints, and to be trained to complete daily routines as a one-handed person.

Disclosure: Dr. Gupta has received research or institutional support from NIH-NINDS.

Source: American Academy of Orthopaedic Surgeons (AAOS)