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A Surgery Master Class


Surgery for the spastic upper limb, which used to be reserved primarily for severe deformities where other options had failed, has gained increased awareness over the recent years, as attested by the large international attendance at two recent Symposia (Paris, 2017 and Venice 2019). It is now recognized as a full part of the treatment options to improve deformities and function of the upper limb.

Today the surgical management of upper limb spasticity focuses on all involved tissues and every joint of the upper limb. Today, the surgical armamentarium includes a great variety of procedures, from skin flaps and releases, nerve procedures, muscle releases, tendon lengthening and transfers, to joint releases and fusions, not to mention neurosurgical procedures.

The first Master Class will be held soon in Budapest.  All positions were claimed quickly, again indicating great interest among surgeons in gaining knowledge and skills in this clinical area and encouraging us at Stanford University to organize the Second Master Class to be held at Stanford, California in May 2020.  This course combining cadaver lab dissections and lectures, will allow the participants to practice these techniques themselves, and become familiar with their respective indications, under the guidance of experts in the field.

Welcome to California and Stanford University.

Vincent Rod Hentz, MD                 Caroline Leclercq
Course Organizer                               Course Chair


Focus:                                     A master class in surgery of the spastic upper limb
Location:                              Stanford University, Stanford, California
Proposed dates:                May 29-30, 2020
Registration:                       Limited to 24 full participants, (on a first come basis)
Costs:                            Full participant - $2,000* (includes lectures, hands-on cadaver                                                     workshops, 2 breakfasts, 2 lunches, course dinner and 2                                                     nights lodging.)

*Note: There may be the opportunity to register as an observer for a reduced fee.

Course Organizers:          Robert A. Chase Hand & Upper Limb Center
Sponsors:                              Stanford University
                                                    Division of Plastic & Reconstructive Surgery,
                                                    Department of Orthopaedic Surgery
Course Chair:                      Caroline Leclercq
Contact:                                 vrhentz@stanford.edu   

Is there a need for a master class in surgery of the spastic upper limb?

There is increasing awareness that there is an expanded role for surgery in managing many deformities of the spastic upper limb other than just correcting the most severe contractures.  Two very well-attended (250+ registrants) symposia (Paris, 2017 and Venice, 2019) demonstrate increased interest among upper limb surgeons in adding to their surgical armamentarium, procedures such as soft tissue contracture release, selective neurectomy, muscle release, tenotomy and tendon transfer, and joint fusions for patients with spasticity of the upper limb secondary to stroke, traumatic brain injury, spinal cord injury and cerebral palsy.

The proposed 2-day course at Stanford University will bring together nationally and internationally recognized experts in the field of surgical management of the spastic upper limb and a small but lucky number of physicians who wish to improve procedures already performed, and more importantly, learn new procedures from these experts.  Lectures focusing on indications will be combined with fresh cadaver workshops where participants can learn from experts and then perform specific procedures for the shoulder, elbow, wrist and hand.  The capacity of the cadaver workshop limits this course to no more than 24 participants, working 2 participants to one fresh cadaver shoulder to hand specimen.  Depending on interest, there is the possibility to accommodate “observers” whose participation will be limited to lectures and demonstrations.

The preliminary program has out of area participants arriving Thursday, May 28th with the course commencing Friday, May 29th and ending sometime Saturday afternoon, May 30th.

A proposed list of procedures to be discussed, demonstrated and practiced include:

1. Tenotomies and tendon lengthening including fractional lengthening for the shoulder, elbow wrist and hand
2. Hyperselective neurectomies for deformities of the elbow, wrist and hand
3. Arthrodesis for wrist and hand
4. Tendon transfers
5. Selective procedures to manage digital deformities such as thumb in palm, swan-neck, joint instabilities

Invited faculty:

Marybeth Ezaki, MD   Dallas, TX
Michelle James, MD  Sacramento, CA
Scott Kozin, MD  Philadelphia, PA
Caroline Leclercq, MD  Paris, France
Scott Oishi, Dallas, TX
Ann Van Heest, MD  Minneapolis, MN