Post-stroke flexed elbow deformity management: consensus opinion from an international Delphi expert panel - 25/09/26
, Vincent T. Carpentier a, b, Laure Gatin a, b, c, Thierry Deltombe d, i, Thierry Gustin e, Stefano Carda f, Philippe Marque g, ad, Paul Winston h, i, Rajiv Reebye i, j, Theodore Wein k, Alberto Esquenazi l, Mary-Ann Keenan m, Franco Molteni n, Paolo Zerbinati o, p, Alessandro Picelli q, Flavia Coroian r, Bertrand Coulet s, Nadine Sturbois-Nachef i, t, Christian Fontaine t, Alain Yelnik u, Bernard Parratte v, Prakash Henry w, Srikant Venkatakrishnan x, Philippe Rigoard y, z, Romain David aa, Philippe Denormandie a, c, Alexis Schnitzler ab, Etienne Allart ac, François Genet a, bHighlights |
• | First international expert consensus on poststroke flexed elbow deformity (FED). |
• | Functional impact assessment drives treatment decisions on poststroke FED. |
• | Distinguishing overactivity from contracture is key in poststroke FED treatment. |
• | Botulinum toxin with rehabilitation is first-line for correctable poststroke FED. |
• | Surgery is recommended for partially or non-correctable poststroke FED. |
Abstract |
Background |
Poststroke flexed elbow deformity is a frequent and disabling abnormal joint posture that impairs function, hygiene, and quality of life. Despite its clinical impact, assessment strategies and treatment sequencing remain heterogeneous, fragmented across disciplines, and poorly standardized.
Objectives |
To establish an international, interdisciplinary expert consensus on the assessment and management of poststroke flexed elbow deformity using a hypothesis-driven Delphi methodology.
Methods |
An international Delphi process was conducted involving 28 experts in physical and rehabilitation medicine, orthopedic surgery, and neurosurgery from 12 countries. Three sequential, anonymous rounds of structured online questionnaires were administered. Statements addressed diagnosis, clinical and instrumental assessment, treatment selection, and surgical indications. Experts rated their agreement with each statement. Consensus was predefined as ≥80% agreement among respondents for a given item.
Results |
Across 3 Delphi rounds, 164 statements were evaluated, of which 61 (38%) reached consensus. Experts, including physical and rehabilitation medicine physicians ( n = 13), orthopedic surgeons ( n = 10), and neurosurgeons ( n = 1) agreed that functional impact assessment must precede treatment decisions and that differentiation between muscle overactivity and soft-tissue contracture is essential. Diagnostic motor nerve blocks and radiological imaging were endorsed as complementary tools in selected cases. Botulinum toxin injections combined with rehabilitation were supported as first-line treatment for correctable deformities, whereas surgical intervention was considered appropriate for partially or non-correctable deformities. Preoperative interdisciplinary consultation and formal goal setting were deemed mandatory before intervention.
Conclusions |
This Delphi-based international consensus provides structured, interdisciplinary guidance for the evaluation and management of poststroke flexed elbow deformity. By clarifying assessment principles, treatment sequencing, and indications for referral and surgery, this consensus aims to standardize care pathways and improve patient-centered outcomes.
Registration |
Not applicable. This study used a Delphi methodology involving expert opinion only, without human participant intervention.
Le texte complet de cet article est disponible en PDF.Keywords : Flexed elbow, Muscle overactivity, Spasticity, Abnormal joint posture, Stroke, Delphi
Abbreviations : BoNT, FE, PMR
Plan
Vol 69 - N° 6
Article 102136- septembre 2026 Retour au numéro
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