Prognostic efficiency of diagnostic blockade as a method of modeling the result of selective neurotomy of the motor branches of the musculocutaneous nerve in patients with cerebral palsy

BACKGROUND: A combination of movement disorders with contractures in the joints is a feature of upper limb lesions in patients with spastic forms of cerebral palsy. As part of the “spastic hand” syndrome, contractures are differentiated into primary and secondary. Primary contractures are caused by muscle spasticity, whereas secondary contractures are caused by the structural shortening of the muscle motor segment in relation to the bone, which can subsequently lead to deformities of articular surfaces. In theory, the use of diagnostic blockade as a mandatory procedure in patient examination before selective neurotomy of the peripheral nerves on the upper limb makes it possible to optimize the result of tone-lowering treatment because of the accurate selection and exact category of patients in whom neurosurgical treatment can be effective.

AIM: To assess the prognostic effectiveness of diagnostic blockade for modeling the result of selective neurotomy of the motor branches of the musculocutaneous nerve in patients with cerebral palsy.

MATERIALS AND METHODS: This longitudinal prospective study included an examination of 31 patients aged 5–17 years with spastic forms of cerebral palsy. Before neurosurgical treatment, each patient underwent a diagnostic blockade of the n. musculocutaneus under ultrasonography and neurostimulation. Before and after the diagnostic blockade and after the neurosurgical treatment, each patient was examined for the amplitude of passive and active joint movements, muscle tone, hand functionality, and dynamometry.

RESULTS: Results of the data analysis showed a significant relationship between the state of the elbow joint during the simulation of surgical treatment and after neurosurgical treatment.

CONCLUSIONS: The study showed the high prognostic effectiveness of diagnostic blockades when deciding on the techniques of treating tonic flexion contractures of the elbow joint as part of the “spastic arm” syndrome. The diagnostic blockade of the musculocutaneous nerve during the planning of surgical treatment makes it possible to create a reliable temporal model of selective neurotomy of the motor nerve branches.