Upper Limb Reconstruction in Upper Motor Neuron Syndrome Clinic Overview

The Upper Limb Reconstruction in Upper Motor Neuron Syndrome Clinic offers specialty care for people who've suffered an upper motor neuron (UMN) injury within their central nervous system and who now have shoulder, elbow, wrist, or hand dysfunction or deformity.

An integrated team of physicians, diagnosticians and surgeons at Mayo Clinic's Rochester, Minnesota, campus brings extensive experience and specialized skills to your personalized care in a compassionate, supportive environment, offering you the most effective options for diagnosis and treatment of upper motor neuron syndrome.

What is upper motor neuron syndrome?

Injury to UMNs within the central nervous system can reduce or dramatically weaken arm or leg muscle control. Upper motor neuron syndrome refers to a combination of resulting symptoms such as muscle weakness, decreased muscle control, easy fatigability, altered muscle tone and exaggerated deep tendon reflexes (also known as spasticity), all of which can occur after a brain or spinal cord injury. The imbalance of muscle forces across a joint can lead to deformities in the limbs that can be disfiguring, disabling and painful.

Are you a prospective patient?

The Upper Limb Reconstruction in UMN Syndrome Clinic evaluates and provides both nonsurgical and surgical options for people with shoulder, elbow, wrist, and hand dysfunction or deformity due to the following conditions:

A team approach to care for the whole person

Mayo Clinic uses an integrated practice model that coordinates care across many specialties and subspecialties for those with UMN syndrome. This team approach provides a thorough evaluation with well-rounded treatment recommendations to enhance function, restore quality of life, facilitate hygiene and improve your upper limb's appearance.

During your one- to two-day comprehensive consultation, you'll receive a thorough evaluation by multiple specialists and likely undergo a series of procedures and tests. Your team will use those findings to recommend a treatment plan that's specific to your individual needs and goals.

Jessica's Story

Nycolle's Story

Mayo's Upper Limb Reconstruction in UMN Syndrome Clinic offers a wide range of expertise, including:

  • A dedicated orthopedic hand surgeon trained in microvascular surgery with extensive experience in treating people with UMN syndrome
  • A compassionate nurse practitioner who will assist you and your family in understanding, coordinating and implementing your treatment plan

Depending on your needs, other team members may include:

  • A physiatrist — for optimization of medical management including Botox injections or baclofen pumps
  • A certified hand therapist — for fabricating any braces and developing your therapy program
  • Occupational therapists — for functional stimulation therapy and providing adaptive equipment to perform daily functions
  • A neurologist — for a comprehensive neurological exam
  • A urologist — for optimizing your bladder and urinary health
  • A psychologist — for enhancing coping skills and screening for anxiety or depression

Innovative surgical procedures to achieve your goals

Mayo Clinic has long been a destination for people seeking answers and the best treatment for their medical problems. The surgical procedures offered within the Upper Limb Reconstruction in UMN Syndrome Clinic rely on evidence-based best practice information. Additional techniques are being developed at Mayo to push the boundaries of surgical care for people with upper limb dysfunction due to a brain or spinal cord injury:

Brain injury

The goal of surgery for people with upper limb dysfunction due to brain injury is to decrease muscle spasticity, correct joint contractures and improve limb appearance, as well as enhance muscle function if voluntary muscle control exists. Mayo Clinic surgeons can strengthen or weaken muscle tone as needed by performing peripheral nerve surgery or by lengthening overactive muscles. Techniques include:

  • Muscle lengthening or release
  • Joint release
  • Hyperselective or complete nerve removal (neurectomy)
  • Tendon transfers
  • Joint fusions

Spinal cord injury

The goals of surgery for people who've suffered spinal cord injuries are to restore elbow straightening (extension), the ability to grasp and the function of pinch. Mayo Clinic surgeons can regain elbow, wrist, finger or thumb function by transferring donor muscles and nerves to paralyzed muscles. Surgical techniques include:

  • Tendon transfers
  • Joint fusions
  • Nerve transfers
  • Muscle lengthening or release

Specialized procedures for unique problems in UMN syndrome

  • Lower limb spasticity. Mayo Clinic hand and microvascular surgeons often cooperate with other orthopedic surgeons to optimize correction of spastic deformities in the hips, knees and ankles, using innovative techniques to decrease spasticity by performing joint releases, muscle lengthening or muscle releases, and targeted nerve surgeries.
  • Chronic ventilator dependency. In people who've had high cervical spinal cord injuries, the nerves that control the diaphragm can become so injured as to require full-time ventilator use for breathing. Mayo Clinic hand and microvascular surgeons can transfer healthy nerves that can be used to electrically stimulate the diaphragm to enable patients to breathe on their own.

State-of-the-art diagnostic tools to optimize treatment plans

Dynamic electromyography (dEMG)

Dynamic electromyography uses surface or fine-wire electrodes placed onto skin or into muscle to evaluate the electrical activity of your key muscles both at rest and with activity. This test provides valuable information about the health of your nerves and muscles, to identify the most effective strategy to target and treat pathological muscles.

Motion analysis

Sensors are placed onto the skin to track the motion of your limbs relative to your body while you're asked to complete various tasks. This information is then analyzed, typically in conjunction with dEMG, to determine how the abnormal nerves and muscles affect your ability to perform basic activities such as walking, sitting, eating and writing.

Engaged in your recovery from afar

The majority of patients travel to the Upper Limb Reconstruction in UMN Syndrome Clinic from around the country and the world. Therefore, dedicated appointment schedulers work hard to facilitate your interdisciplinary evaluation at Mayo Clinic. If you need surgery, you'll typically return for your procedures with an anticipated four- to five-day stay in Rochester, Minnesota. Resources are provided to assist you and your family in coordinating delivery of medical equipment and supplies to local hotels, arranging for wheelchair-accessible transportation if needed, and scheduling in-room nursing care at your lodging nearby.

After surgery, a personalized therapy plan is taught both to you and to your caregivers so it can be performed when you return home. If needed or requested, rehabilitation is coordinated with your local therapists who maintain regular communication with your surgical team at Mayo Clinic. Patients often return at two weeks, six weeks and 12 weeks after surgery for standard postoperative care and advancement of rehabilitative techniques. Through it all, your team is a phone call or online message away to ensure that, despite the distance, you receive high-quality care throughout your recovery.


Please email: UMNSYNDROMECLINIC@mayo.edu

Oct. 31, 2023