Upper extremity involvement is present in approximately 80% of patients with cerebral palsy. Orthopedic surgical intervention can be used to correct abnormalities of the upper extremity in these patients.
Potential problems include:
- Shoulder internal rotation
- Wrist and elbow flexion contractures
- Thumb adduction contractures
- “Swan-neck” deformities of the fingers
- Forearm pronation
- Thumb-in-palm
The surgical concepts related to this complex neurologic problem must be kept rather simple, and include principally the release of spastic deforming muscles, and, secondly, the use of augmentation tendon transfers to maintain an improved functional position.
The most important aspect of surgical planning is to assess whether or not the individual is attempting to use the upper extremity voluntarily. In patients that are, surgical procedures can reposition the deformed limb and enable the patient to function more effectively.
Alternately, it is most important to understand that an orthopedic intervention will not stimulate an individual to begin to use a previously functionless limb.
DeLuca PA. Common orthopedic problems II: the musculoskeletal management of children with cerebral palsy. Pediatr Clin N Am 1996;43:1135-50.