Spasticity holds a limb in a fixed position: the elbow bent, the wrist flexed, the thumb buried in the palm. Surgery lengthens, releases or rebalances the muscles pulling it there. It changes position reliably; it changes control much less.
Spastic muscle surgery rebalances a limb held tight by spasticity, most often from cerebral palsy or after a brain injury or stroke. Tight muscles and tendons are lengthened or released, and sometimes a working tendon is moved to replace one that cannot be used. The realistic aims are a better resting position, easier hygiene and dressing, relief of pain, and in selected patients improved grasp.
Spasticity comes from the brain or spinal cord, not from the muscle. Surgery cannot repair that, and being clear about this at the outset prevents a great deal of disappointment.
What surgery can change is the mechanical consequence. A muscle held permanently short eventually becomes fixed and no amount of stretching will lengthen it. That fixed shortening, called contracture, is what pulls the wrist flexed, the thumb into the palm and the elbow bent, and it is a mechanical problem with a mechanical solution.
Three things are done, often together. Tight muscles and tendons are lengthened so the joint can reach a better position. Fixed structures across a joint are released. And where one muscle group is overpowering a paralysed or weak opposite group, a working tendon is moved to restore some balance.
Assessment matters more than technique here. A limb with no voluntary control gains position and hygiene but not function. A limb with some control underneath the spasticity can gain real function, and separating those two situations before operating is the core of the work. Botulinum toxin is often used first, partly as treatment and partly to show what a release would achieve.
The aim has to be agreed before the operation, because the same procedure is a success or a failure depending on what was expected of it.
Joint ranges are checked with the muscles relaxed, which separates fixed contracture from dynamic spasticity.
Tendons are lengthened in a controlled way, enough to reach a better position without losing all power.
Tight joint capsules and bands crossing the joint are released where the tendon alone does not account for the deformity.
Where a working muscle can be spared, it is moved to help an opposing group and rebalance the limb.
A splint is applied in theatre in the corrected position, so the gain is held from the outset.
Splint in place, elevation for swelling. Simple pain relief. The limb is kept in the corrected position throughout.
Therapy begins in earnest: range of movement, then strengthening, with a night splint continuing.
Functional retraining if a transfer was done. The new movement has to be learned, which takes months and effort.
Long term night splinting in many children, with review for recurrence during growth.
Position, hygiene and comfort improve reliably and are the most common reasons to operate. Functional gain is real but selective, and depends heavily on whether there was voluntary control and useful sensation to begin with. Spasticity itself continues, so splinting and therapy continue afterwards, and in growing children deformity can recur and need further surgery. None of this makes the operation not worth doing; it makes agreeing the goal beforehand essential.
Over correction is as much a problem as under correction in this work.
Therapy and splinting after surgery are not an add on. They are half the treatment.
Spasticity comes from the brain or spinal cord. Surgery addresses the shortened muscles and joints that result from it. Tone management continues afterwards.
Position and function are different things. A hand can be straightened and still not grasp, particularly where sensation is poor. Which one is being aimed for should be agreed before surgery.
In growing children deformity can recur, and staged procedures are common. That is planned rather than a sign that something failed.
The most useful thing in spasticity surgery is an honest assessment of what the limb will do afterwards. Operating on a hand with no sensation and no voluntary control, expecting grasp, helps nobody.
Functional surgery for spasticity is commonly covered by health insurance and by government schemes. Cost depends on how many muscle groups are addressed and whether more than one limb is treated. Therapy afterwards is an ongoing cost and is planned for from the start. A written estimate follows assessment.
The questions that matter most before agreeing to surgery.
Ask your question →Usually not normally. The honest question is whether there is voluntary control and sensation underneath the spasticity. Where there is, grasp and release can improve meaningfully. Where there is not, the gains are position, hygiene and comfort, which are still worth having.
It temporarily reduces tone, which does two things: it may be enough on its own, and it shows what the limb would look like if the muscle were lengthened. That preview is genuinely useful before committing to surgery.
In growing children it can, because the spasticity continues while the bones lengthen. Night splinting and stretching reduce that, and further surgery is sometimes needed during growth.
No. The same principles apply after stroke, head injury and spinal cord injury in adults, where a limb has become fixed in a position that causes pain or interferes with care.
Then that has to be part of the decision. Surgery without therapy afterwards frequently loses the gain, and it is better to say so beforehand than to operate and watch it tighten again.
Seeing patients from across the city and beyond: read about the practice on the plastic surgeon in Surat page, or check what a written estimate covers on the costs and insurance page.
