From the Guidelines
Thoracodorsal nerve neurectomy is not a recommended treatment for spasticity based on the provided evidence. The most recent and highest quality study, 1, does not mention thoracodorsal nerve neurectomy as a treatment option for spasticity. Instead, it recommends a combination of physical and pharmacological modalities, such as range-of-motion exercises, heat, cold, and electric stimulation, and oral medications like dantrolene and tizanidine.
Treatment Options for Spasticity
The following treatment options are recommended for spasticity:
- Oral medications like dantrolene and tizanidine 1
- Botulinum toxin injections for targeted muscles or muscle groups 1
- Intrathecal baclofen for severe spastic hemiplegia 1
- Physical approaches like range-of-motion exercises, heat, cold, and electric stimulation, and splinting 1
Considerations for Thoracodorsal Nerve Neurectomy
While thoracodorsal nerve neurectomy may be considered in some cases, it is not a recommended treatment option based on the provided evidence. The procedure involves selectively cutting the thoracodorsal nerve to reduce abnormal muscle tone and involuntary contractions, but its effectiveness and safety are not supported by the most recent and highest quality studies.
Recommendations for Spasticity Management
The management of spasticity should prioritize a combination of physical and pharmacological modalities, as recommended by the most recent and highest quality studies 1. Patients should be assessed for spasticity and treated accordingly, with a focus on improving quality of life and reducing activity limitations.
From the Research
Thoracodorsal Nerve Neurectomy for Spasticity
- The effectiveness of thoracodorsal nerve neurectomy in treating spasticity has been investigated in several studies 2, 3, 4, 5, 6
- A study published in 2020 found that symptomatic muscle spasticity or involuntary muscle movement occurs in a small number of patients with latissimus dorsi breast reconstruction and is not affected by thoracodorsal nerve transection 2
- In contrast, a 2023 study found that hyperselective neurectomy of the thoracodorsal nerve is effective and stable in the treatment of shoulder spasticity, with significant improvement in shoulder mobility and reduction in muscle spasticity 3
- Another study published in 2014 found that denervation of the latissimus dorsi muscle by resecting more than 4 cm of the thoracodorsal nerve can prevent postoperative muscle twitching and discomfort 5
- A review of evidence published in 2019 found that thoracodorsal denervation is a safe and reliable procedure that can improve outcomes in latissimus dorsi breast reconstruction, but highlighted the need for a systematic approach to this clinical challenge 6
Surgical Techniques and Outcomes
- The surgical technique for thoracodorsal nerve neurectomy involves dissecting and observing the branching patterns of the nerve, counting the number of nerve branches, and measuring the distribution of branch origin points 3
- The length of nerve resection is an important factor in preventing postoperative muscle twitching, with resection of more than 4 cm recommended 5
- Outcomes measurements for thoracodorsal nerve neurectomy include shoulder mobility, muscle spasticity, and patient-reported symptoms of breast animation 3, 5, 6
Clinical Applications and Limitations
- Thoracodorsal nerve neurectomy has been used to treat shoulder spasticity and prevent postoperative muscle twitching in latissimus dorsi breast reconstruction 2, 3, 5
- However, the procedure may not be effective in all cases, and further research is needed to fully understand its clinical applications and limitations 2, 6
- Additionally, the optimal method of nerve management is unknown, and a systematic approach to thoracodorsal denervation is needed to improve outcomes in latissimus dorsi breast reconstruction 6