Triceps Neurectomy for Management of Elbow Extension Spasticity

Abstract

Introduction: Neurectomy for elbow flexion spasticity has been described, but its role in elbow extension spasticity is not well defined. Triceps spasticity can affect arm posture, function, and ease of care and transfers from a wheelchair. Tendon lengthening of the triceps in combination with hyperselective neurectomy (HSN) has previously been reported, with favorable outcomes. The role of neurectomy alone for triceps spasticity, however, is not well described. Methods: We performed a single-center, retrospective review of patients who underwent triceps selective neurectomy (TSN) between April 2022 and August 2025. Through a posterior approach, radial nerve motor branches to the triceps were identified and stimulated, with 60-70% of the cross-sectional innervation to the triceps muscles transected, and a 1-2 cm segment of motor nerve excised. Demographics, spasticity etiology, and concurrent procedures were recorded. Outcomes included spasticity (Modified Ashworth Scale [MAS], Tardieu Scale), passive range of motion (ROM), and resting elbow position. Results: Five patients underwent six procedures (one bilateral). Mean follow-up was 14 (range: 2-36) months. Etiologies of extension spasticity included cerebral palsy (n=4) and stroke (n=1). Three extremities presented with primary triceps spasticity, two developed spasticity following flexor release, and one underwent concomitant flexor and extensor neurectomies. Concurrent procedures included tendon transfer (superficialis to profundus transfer and FCU to ECRB; n=3) and pectoralis lengthening (n=2). Spasticity was markedly improved post-procedure, as MAS decreased from 3 to 0.7 and Tardieu from 3.5 to 1. Complete resolution of spasticity was achieved in 2 extremities. Resting elbow posture improved from full or near-full extension to a mean 38° of flexion. Passive ROM increased from 20° to 93°. One patient developed mild recurrence at 36 months. Conclusion: TSN alone safely reduces spasticity, improves passive mobility, and restores functional posture without the need for concomitant triceps lengthening. These findings support TSN as a viable option for elbow extension spasticity.