Orthopedic Treatment Vital to Stroke Recovery

Orthopedic treatment is a vital part of the recovery process of stroke victims, helping them return function in the shoulders, arms, and hands.

Researchers at the University of California, Irvine (Irvine, CA, USA) reviewed current literature and suggest that proper treatment of patients with nonfunctional arms and legs following a stroke should begin with a careful examination of the patient to identify deformities of the shoulder, elbow, forearm, wrist, fingers, and thumb. Tests such as electromyography (EMG), a test that 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. These may include, but are not limited to, positioning the arm or leg to make the patient more comfortable, range of motion (ROM) exercises, splinting to prevent muscle spasms, use of medications to reduce pain and eliminate muscle spasms, and electrical stimulation to activate nerves.

After six months, 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. The surgical procedures on patients with nonfunctional arms and legs following a stroke are often more aggressive, and are primarily performed to address issues of hygiene and to make the patient more comfortable.

The surgical treatment of functional and nonfunctional 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. With proper orthopedic treatment, stroke patients can hope to achieve a reduction in their pain, greater ROM, and a more aesthetically pleasing appearance of the deformed limb. The article was published in the August 2008 issue of the Journal of the American Academy of Orthopaedic Surgeons (JAAOS).

"Orthopedic 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,” said senior author Ranjan Gupta, M.D., chair of the department of orthopedic surgery. "It is critical for the orthopedic surgeon to become involved in the management of these patients immediately following the stroke, to ensure the best possible outcome.”

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University of California Irvine