Neuroorthopaedics

Neuroorthopedics deals with the consequences of neurological disorders on the musculoskeletal system: muscles, tendons, bones and joints. Typical issues include spasticity, paralysis, gait disorders, misalignments or pain that arise from impaired muscle control. The causes range from stroke, multiple sclerosis (MS) and cerebral palsy (CP) to peripheral nerve lesions, intervertebral disc disease with nerve root involvement or neuromuscular diseases.

• Focus: spasticity management, gait and balance analyses, orthosis care, pain and functional treatment
• Approach: conservative first; Invasive procedures are explained in a targeted, indication-based and transparent manner
• Interdisciplinary: close collaboration with neurology, physiotherapy, occupational therapy and pain medicine

Movement arises from the interaction of the brain and spinal cord (central nervous system), peripheral nerves, muscles, tendons and joints. If a component is disturbed, the movement pattern changes. Upper motor neuron (e.g. in stroke) often leads to spasticity and coordination problems. Lower motor neuron (e.g. peripheral nerve lesion) is more likely to cause muscle weakness, atrophy and loss of reflexes. There are also sensory influences such as proprioception and balance, which significantly control posture and gait.

• Upper motor neuron: spasticity, increased muscle reflexes, coactivation
• Lower motor neuron: flaccid paralysis, muscle wasting, decreased reflexes
• Cervical region: Cervical spine function affects head control, balance and neck-head pain

• Spasticity after stroke, MS or cerebral palsy: increased muscle tension, painful cramps, limited hand or foot function
• Foot drop weakness (peroneal palsy): stumbling, foot dragging; Need for orthoses or functional electrical stimulation
• Contractures and misalignments: e.g. E.g. equinus, knee flexion contracture, thumb-in-hand position
• Scoliosis and trunk instability in neuromuscular diseases
• Peripheral nerve entrapment syndromes: carpal or tarsal tunnel syndrome, ulnar groove syndrome
• Shoulder-arm problems after neurological events: shoulder pain, scapula alata, limitation of use of the hand
• Unsteady gait, risk of falling and balance disorders (also with cervical involvement)

Depending on the findings, we create an individual plan that takes function and everyday situations into account - from safe walking to gripping to relieving painful areas.

The workup combines clinical examination, functional tests and, if appropriate, technical procedures. The aim is to identify the factors that can be influenced and to set realistic therapy goals.

• Detailed anamnesis: previous illnesses, neurological diagnoses, everyday limitations, falls, therapy experiences
• Clinical functional analysis: muscle strength, tone (e.g. modified Ashworth or Tardieu scale), joint mobility, coordination
• Gait and posture assessment: with and without aids; if necessary, video analysis
• Additional neurological diagnostics according to indication: EMG/ENG, nerve ultrasound, imaging (MRI/CT) via cooperation partners
• Scales and goal agreement: Goal Attainment Scaling (GAS) for everyday-relevant success measurement

The focus is on measures that promote function, reduce pain and enable participation. The selection depends on the cause, characteristics and your goals.

• Physiotherapy: Tone regulation, stretching and mobilization programs, strengthening weak muscle groups, balance and gait training
• Occupational therapy: arm-hand function, everyday training, advice on aids, splint provision
• Pain therapy: local and systemic as needed; weighed up with regard to side effects and overall medication
• Nerve and soft tissue techniques: nerve mobilization, myofascial techniques, taping
• Functional electrical stimulation (FES) or TENS as indicated
• Training with aids: crutches, walker, adjustment of step and shoe technique

Antispastic medications (e.g. baclofen, tizanidine) can be considered in collaboration with neurologists or family doctors. The effectiveness is checked regularly; Dosage adjustments are made cautiously.

Properly selected and adjusted aids can support safety, energy efficiency and pain reduction. Individual adaptation and accompanying training are crucial.

• Lower leg orthoses (AFO) for foot drop weakness or equinus tendon
• Wrist and thumb orthoses for stabilization and contracture prevention
• Night positioning splints and serial casts for checking tone and contracture
• Seat shells, positioning aids and body supports for trunk and scoliosis problems
• Special insoles for sensory or muscular asymmetries
• FES systems for foot elevation when clinically appropriate

For focal spasticity, botulinum toxin may be an option to temporarily relax overactive muscles. The decision is made based on clearly defined goals (e.g. easier dressing, better standing).

• Ultrasound and/or EMG-assisted injection technology for precise dosage
• Effect limited in time (typically 3–4 months), regular reevaluation
• Combination with physiotherapy and splint care is crucial
• Information about possible side effects (e.g. temporary muscle weakness, local pain)

Not all spasticities benefit from injections. If there is a diffuse increase in tone, pronounced contractures or a lack of functional goals, other strategies are in the foreground.

Orthobiological treatments (e.g. the body's own preparations) can be considered if there are accompanying tendon or joint problems. Evidence for the direct treatment of neurologically caused paralysis is currently limited. We clarify benefits, risks and alternatives transparently and decide together.

• Use primarily for musculoskeletal comorbidities (e.g. tendinopathies, irritations)
• No application without comprehensible objectives and realistic clarification of expectations
• Interdisciplinary coordination, e.g. B. via the Institute for Regenerative Movement Medicine

Needs differ depending on the phase of life. Children with cerebral palsy need growth-accompanying strategies to avoid contractures and abnormal development. Adults often face challenges following a stroke, MS or peripheral nerve lesions. In both groups, everyday goals and relieving the burden on relatives are important.

• Children: Tone management, orthosis and splint concepts, prevention of contractures and hip problems
• Adults: gait and balance training, fall prevention, pain management and optimization of aids
• Continuous adaptation of the measures to development, course of the disease and life situation

• Regular stretching and exercise programs according to instructions
• Consistent use of orthoses and aids with appropriate care and follow-up checks
• Recognize and reduce spasticity triggers: stress, pain, full bladder, infections
• Skin and pressure point control, especially in the case of sensitive deficits
• Fall prevention: adapt living environment, non-slip shoes, good light
• Realistic goal planning in small steps; Document successes

If you notice any of the following signs, you should seek immediate medical attention. If an emergency is suspected (e.g. sudden severe paralysis, loss of bladder or bowel control, severe new headache), please contact the emergency services immediately.

• Sudden paralysis or loss of feeling in an arm/leg
• Acute bladder or rectal disorder, breeches anesthesia
• New severe headache, neck stiffness, fever
• Rapid loss of strength after trauma or severe back pain
• Rapid increase in deformity with skin problems

Neuroorthopedic issues benefit from short distances. In Hamburg we work closely with neurology, physiotherapy and specialized centers to coordinate diagnostics and therapy. Depending on the symptoms, cervical and head structures can also play a role.

• Cervical complaints, headaches or dizziness: Cooperation with specialized centers
• Back pain with nerve involvement: structured assessment and conservative treatment paths
• Regenerative options for accompanying problems: after information and indication testing

You can find us at Dorotheenstraße 48, 22301 Hamburg. If possible, bring preliminary findings (doctor's reports, imaging, orthosis protocols) and a list of your medications with you. This allows us to assess the situation in a targeted manner and formulate realistic goals with you.