Cerebral palsy of the upper extremity

Area of Science:

• Orthopedic Surgery
• Pediatric Neurology
• Rehabilitation Medicine

Background:

• Upper extremity spasticity in cerebral palsy is often overlooked compared to spinal and lower limb issues.
• Despite challenges, surgical interventions for upper extremity spasticity can yield meaningful functional improvements.

Purpose of the Study:

• To outline a simplified surgical approach for managing upper extremity spasticity in cerebral palsy.
• To emphasize the importance of patient's voluntary use of the limb in surgical planning.

Main Methods:

• Surgical concepts focus on releasing spastic muscles and utilizing tendon transfers.
• Preferred tendon transfers involve muscles contributing to the deformity for natural function post-transfer.
• Surgical planning prioritizes assessing the patient's intent to use the affected upper extremity.

Main Results:

• Simple surgical strategies can improve upper extremity function in spastic cerebral palsy.
• Tendon transfers using existing deforming muscles can correct deformities with minimal retraining.
• Surgery can enhance function in limbs with existing voluntary use, but does not initiate use in non-functional limbs.

Conclusions:

• A straightforward surgical approach involving muscle release and tendon transfers is effective for upper extremity spasticity in cerebral palsy.
• Careful surgical planning, considering the patient's voluntary use, is crucial for successful outcomes.
• Surgical interventions aim to optimize function in existing usable limbs, not to create function in previously non-functional limbs.