We evaluated if spasticity-reducing surgery in the upper extremity could improve motor function, fulfill patient's specific goals and influence performance of daily activities in patients with muscle overactivity.

Thirty consecutive patients with spasticity due to various CNS injuries were evaluated pre- and post-surgery and followed one year by the team consisting of physician, physiotherapist and occupational therapist.

Prior to surgery the patients’ clinical problem related to spasticity was defined and motor function and activity was assessed. Each patient's potential to comply with the post-surgical rehabilitation procedure was estimated and the intensity level chosen (low, moderate or high). The surgical intervention comprised lengthening of tendons, release of muscles and occasionally deformity corrections.

Physiotherapy, occupational therapy, wrapping and application of orthoses started the first postoperative day. Patients were taught how to perform a home-training program. One week of intensive in-hospital rehabilitation followed 2–3 weeks after surgery and a new home-training program was designed. Subsequent follow-up visits were scheduled at 3, 6 and 12 months.

General hand function (usefulness) and pain were evaluated using the VAS scale (0–10), spasticity using the Modified Ashworth Scale (0–5) and activity by COPM (mean values of performance and satisfaction). Wilcoxon signed rank test was used.

At one year follow-up patients’ assessment of general hand function increased, 2.1 vs. 4.2 (P<0.001), pain decreased, 3.0 vs. 1.7 (P<0.05), and spasticity decreased, 3.5 vs. 2.1 (P<0.001). Both activity measures improved: performance 2.0 vs. 5.5 (P<0.01) and satisfaction 1.9 vs. 5.5 (P<0.01).

In patients with disabling spasticity, hand surgery combined with comprehensive rehabilitation reduced muscle overactivity, improved hand function, reduced pain, and promoted patient ability for arm-hand activities and satisfaction in daily life at one year follow-up.