Types of surgical procedures for spasticity

• Tendon Lengthening Over time, chronically spastic muscles can shorten and cause the tendons to become tight, leading to contractures and joint stiffness. Tendon lengthening procedures involve making small cuts in the tendons (such as the Achilles tendon, hamstring, or wrist flexors) to increase their length. This allows the joint to move more freely and restores a more natural limb posture. It’s particularly helpful in improving gait in children with cerebral palsy or releasing wrist and finger tightness in upper limb spasticity.
• Muscle Releases Selective release of overactive or shortened muscles can relieve fixed deformities and restore balance to muscle groups. By surgically releasing part of a muscle or fascia, the limb can achieve a more functional range of motion. This is often combined with tendon lengthening and is commonly done in the hamstrings, adductors, and upper limb flexors.
• Neurectomy or Nerve Release In cases where spasticity is driven by persistent nerve overactivity, surgical neurectomy (partial cutting of the motor nerve) or nerve decompression may be performed. This reduces abnormal muscle contractions and allows better voluntary control. The procedure is often used for targeted muscle groups and can be tailored to the individual’s pattern of spasticity.
• Joint Stabilisation and Reconstructive Surgery Chronic spasticity can lead to dislocated or unstable joints, especially in the hips, knees, elbows, or shoulders. In such cases, joint stabilisation procedures — including tendon transfers, osteotomies (bone realignment), or capsular tightening — may be performed. These surgeries aim to preserve or improve joint alignment, prevent further damage, and optimise limb use or positioning.

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