The spastic upper limb in children with cerebral palsy
1Department of Paediatric Orthopaedic and Reconstructive Surgery, Centre de Référence STREAM, Sorbonne Medical University, Trousseau Hospital, 26 Avenue du Dr Arnold Netter, 75012 Paris, France.
Hand Surgery & Rehabilitation
|July 1, 2026
Summary
Surgery offers durable correction for upper limb contractures in children with cerebral palsy (CP). This review details surgical options for shoulder, elbow, forearm, wrist, and hand to improve function, posture, and aesthetics.
Area of Science:
- Orthopedic surgery
- Pediatric rehabilitation
- Cerebral palsy management
Background:
- Management of pediatric cerebral palsy (CP) upper limb dysfunction is complex.
- Non-surgical methods (physiotherapy, occupational therapy, orthoses, botulinum toxin) are initial treatments.
- Surgery is crucial for durable correction of contractures and functional improvement.
Purpose of the Study:
- To review current surgical indications and techniques for the upper limb in children with CP.
- To provide an update on surgical options across all upper limb segments.
- To emphasize practical considerations for hand surgeons.
Main Methods:
- Systematic review of surgical techniques and indications.
- Anatomical segmentation of the upper limb (shoulder to thumb).
- Discussion of tailored procedures based on spasticity, contracture, and functional goals.
Main Results:
- Surgical interventions can durably correct contractures, rebalance forces, and improve posture.
- Procedures are specific to anatomical location (shoulder, elbow, forearm, wrist, fingers, thumb).
- Expected outcomes are presented for each surgical approach.
Conclusions:
- Surgical management is essential for significant upper limb deformities in pediatric CP.
- Individualized surgical plans are key to optimizing functional outcomes.
- This review serves as a practical guide for surgeons managing pediatric CP upper limb conditions.
