The same dysfunction that takes place in the foot can take place further up the leg, so sometimes the patient's legs, will scissor. That is the adductors where muscles that pull the legs towards one another, can be overactive making it difficult to swing the leg in front. We can do the same procedure on the nerve, supplying those adductor muscles, trimming it back, relaxing that spasticity, and creating a normal swing phase of the gait so they can walk better. These procedures aren't limited just to the leg. These procedures are available to the arm and hand. Typically, the function of the arm and hand after a stroke is characterized by adduction and internal rotation of the shoulder. That is the arm is pulled into the side and turned in so the forearm is against the abdomen. At the same time the elbow is flexed, the wrist is flexed, pronated, that is the hand turned down towards the floor and the fingers are clenched. Sometimes there is some degree of function. The patient is able to open the fingers or extend the arm a little bit, but some of the muscles are interfering with that action. We can usually identify which muscles these are and find the branches to them and trim them back and eliminate this dysfunction. Sometimes the patient's arm and hand can be completely dysfunctional where there is no active motor control at all. When this is the case, often hygiene is a problem or even simple daily tasks such as getting clothes on the arm. When this is the case, we can relax these muscles or these nerves entirely to allow the arm to fall down to the side and a more relaxed position making placing clothes or washing the arm, cleaning the arm, much more simple. When we find that the patient has some underlying motor control, they can clench the hand, they can flex the elbow, yet other muscles are getting in the way, this is usually an ideal candidate to find a dysfunctional muscles, trim them back and achieve much more normal function, once again. So patient who had no ability to pick up a fork or bring a cup to their mouth after these procedures, they often can regain that type of control.
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