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Surgical Treatment of Pediatric Upper Limb Spasticity: The Wrist and Hand
Mitchel Seruya1, Ryan M Dickey2, Abdulla Fakhro2
1Division of Plastic and Maxillofacial Surgery, USC Keck School of Medicine, Los Angeles, California.
Insights
Pediatric upper limb spasticity causes contractures like wrist flexion and thumb-in-palm. Surgical interventions and hand rehabilitation can correct these deformities, improving function.
Area of Science:
- Orthopedics
- Pediatric Rehabilitation
- Neurology
Background:
- The wrist and hand's functional positioning relies on extrinsic and intrinsic muscle balance.
- Spasticity disrupts this balance, impairing upper limb interaction with the environment.
- Pediatric patients often present with wrist flexion, thumb-in-palm, and flexed finger postures due to spasticity.
Purpose of the Study:
- To discuss the surgical correction of upper limb spasticity contractures in pediatric patients.
- To highlight the importance of diagnosis, surgical planning, and rehabilitation for successful outcomes.
Main Methods:
- Review of surgical techniques for correcting spasticity-related contractures.
- Discussion of tendon release, lengthening, or transfer procedures.
- Consideration of total wrist arthrodesis and proximal row carpectomy for severe wrist deformities.
Main Results:
- Surgical interventions can effectively correct abnormal postures caused by spasticity.
- A combination of surgical correction and consistent hand rehabilitation is crucial.
- Proper diagnosis and surgical planning lead to successful outcomes.
Conclusions:
- Surgical correction of spasticity-induced contractures in pediatric upper limbs is feasible.
- A multidisciplinary approach involving surgery and rehabilitation is key to restoring function.
- Achieving successful surgical outcomes requires accurate diagnosis and meticulous surgical execution.
Abstract:
The wrist and hand are essential in the placement of the upper extremity in a functional position for grasp, pinch, and release activities. This depends on the delicate balance between the extrinsic and intrinsic muscles of the wrist and hand. Spasticity alters this equilibrium, limiting the interaction of the upper limb with the environment. Classically, pediatric patients with upper limb spasticity present with a flexed wrist, thumb-in-palm, and flexed finger posture. These contractures are typically secondary to spasticity of the extrinsic flexor muscles of the wrist and hand and intrinsic muscles of the thumb and digits. Tendon release, lengthening, or transfer procedures may help correct the resultant abnormal postures. A total wrist arthrodesis with or without proximal row carpectomy may help address the severely flexed wrist deformity. With proper diagnosis, a well-executed surgical plan, and a consistent hand rehabilitation regimen, successful surgical outcomes can be achieved.
