The spastic shoulder can often result from brain injury that causes disruption in the upper motor neuron inhibitory pathways. Patients develop dyssynergic muscle activation, muscle weakness, and contractures and often present with fixed adduction and internal rotation deformity to the limb. This article reviews the importance of a comprehensive preoperative evaluation and discusses appropriate treatment strategies based on preoperative evaluation.
Key points
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Spastic shoulder deformity can cause substantial limitation in active and passive upper extremity function.
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When deformities and lack of function persist and neurologic recovery has plateaued, preoperative planning should be initiated.
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The key is to characterize the patient’s motor control using a comprehensive physical examination, and when indicated, dynamic polyelectromyography and selective local anesthetic nerve blocks to identify the offending muscles.
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Treatment options include selective tendon releases, fractional tendon lengthenings, biceps suspension, arthrodesis, and arthroplasty, and must be determined after a careful review of the patient’s specific clinical presentation.
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