Clinical
Briefing: Surgical Recovery of Function and
Mobility in Post-CVA Patients
July/August 2007
Neuro-Orthopaedics is the specialty of restoring function and mobility to patients
with neurological disorders or injuries. Under the direction of Mary Ann Keenan, MD,
the Penn Neuro-Orthopaedic service uses a variety of innovative orthopaedic surgeries
to meet the challenging needs of these people.
The most common disorders treated include stroke, traumatic injuries of the brain
and spinal cord, cerebral
palsy, and polio. Many patients also develop arthritis requiring
total joint replacement. The Penn Neuro-Orthopaedic service specializes in performing
these joint reconstructions.
Sometimes neurological injury causes the abnormal growth of extra bone called
Heterotopic Ossification (HO). This new bone surrounds joints and severely limits
movement. Abnormal bone must be surgically removed, while preserving normal bone
to re-establish movement.
“Our objective at
the Penn Neuro-Orthopaedic service is to restore
physical performance whenever possible, and
to improve quality of life whatever the
circumstances.”
– Mary Ann Keenan, MD
Chief, Neuro-Orthopaedics Service |
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Case Study
Mrs. L, a 45-year-old teacher, presented to the Penn Neuro-Orthopaedic service
with pronounced spastic hemiplegia almost two years after a severe stroke forced
her to give up her career. Her initial examination revealed residual right-sided paresis,
as evidenced by an equinovarus foot deformity, the inability to flex her knee while
walking, and resulting gait dysfunction. In addition, Mrs. L had lingering dysarthria, a
pronounced shoulder subluxation, and impaired muscle control affecting the movement
of her hand.
Mrs. L had surgery to correct her equinovarus clubfoot. She also had a tendon
transfer procedure at her knee, which redirected the force of the muscle and allowed
her knee to bend while walking. Her shoulder subluxation was treated using a tendon
suspension procedure to reposition and hold the humerus in the shoulder joint. This
alleviated her pain and allowed mobility of her shoulder. She also had surgery to
improve her hand function.
Previously, Mrs. L needed to use a cane and rigid short leg brace even to walk
short distances. Today, Mrs. L is able to ambulate independently and fluidly without a
brace. She can now challenge many of the other limitations imposed by her stroke. She
has begun speech therapy and physical therapy to strengthen and increase the dexterity
of her fingers. Most importantly, her hope of returning to teaching has been renewed.
Specialists in Restorative and Rehabilitative
Orthopaedic Care
The Penn Neuro-Orthopaedics service is internationally recognized
as the world leader in this important field. Our board certified
orthopaedic surgeons are committed to treating patients according
to their own specific needs. They collaborate extensively
with other physicians and professionals in neurology, neurosurgery
and rehabilitation medicine.
They have pioneered evaluation
and treatment techniques for improving mobility in the neurologic
patient. They serve on the boards of several prestigious
orthopaedic journals, are invited to speak at national and
international meetings, have published numerous scientific
papers, and have written textbooks on this specialty.
Our Team of Faculty: Neuro-Orthopaedics
Mary Ann E. Keenan, MD
Chief, Neuro-Orthopaedics Service
Professor and Vice Chair of Orthopaedic Surgery
Hospital of the University of Pennsylvania
and Pennsylvania
Hospital
Helen Horstmann, MD
Associate Professor of Orthopaedic Surgery
Hospital of the University of Pennsylvania
Access
Patient appointments are available at:
Penn Orthopaedic Institute
Hospital of the University of
Pennsylvania
2 Silverstein
3400 Spruce Street
Philadelphia, PA 19104
Pennsylvania Hospital
800 Spruce Street
Philadelphia, PA 19107
To refer a patient and/or consult with a doctor:
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Referring Physicians: To speak with a Penn physician
or refer a patient, contact PennHealth through the secure online
referral form or by calling
1-800-789-PENN
(7366). |
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