Orthopaedic Surgeons Play Key Role in Stroke Recovery

Greater motion and improvement in daily living are among goals

ROSEMONT, Ill., Aug. 27 /PRNewswire-USNewswire/ -- 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 (http://www.jaaos.org/ ).

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
(http://orthoinfo.aaos.org/topic.cfm?topic=A00270 ), 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.

JAAOS (http://www.jaaos.org/ )

About AAOS
(http://www6.aaos.org/news/Pemr/releases/release_boiler.cfm?category=8&releasenum=702
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www.orthoinfo.org

SOURCE American Academy of Orthopaedic Surgeons

Catherine Dolf, +1-847-384-4034, (C) +1-847-894-9112, dolf@aaos.org or Lauren
Pearson, +1-847-384-4031, (C) +1-224-374-8610, lpearson@aaos.org, both of the
American Academy of Orthopaedic Surgeons