Surgical technique for thumb-in-palm deformity in cerebral palsy

The most common surgical procedure performed by hand surgeons in cerebral palsy for thumb-in-palm deformity is release of the adductor pollicis muscle from the middle metacarpal origin, with additional release of the thenar muscles or flexor pollicis longus, as indicated, to decrease the flexion adduction forces across the first ray. Tendon transfer to augment extension and abduction of the thumb metacarpal will help avoid recurrence, and it commonly includes rerouting of the extensor pollicis longus. Stabilization of the metacarpophalangeal joint might be necessary if hyperextension deformity exists. The assessment of the patient should occur over several visits to determine the correct combination of procedures that will best help the patient achieve a more functional upper extremity or improve hygiene. With appropriate planned procedure, meticulous surgical technique, and adherence to a postoperative rehabilitation regimen, patients can obtain substantial improvement with thumb-in-palm surgical re-positioning.