The spastic upper limb in children with cerebral palsy

Management of the upper limb in children with cerebral palsy is complex and requires a multidisciplinary approach. Non-surgical interventions such as physiotherapy, occupational therapy, orthoses and botulinum toxin are first-line treatments, but surgery remains the only option to durably correct contractures, rebalance forces, and improve posture, function, hygiene or aesthetics. Surgical procedures must be tailored to the anatomical segment involved, the degree of spasticity and contracture, and the functional goals defined with the patient and the family. The surgical techniques and indications are described according to the anatomical location throughout the upper limb, with detailed presentation of the procedures and the expected outcomes. This review provides an update on surgical indications, technical options and strategies for the shoulder, elbow, forearm, wrist, fingers and thumb, with emphasis on practical considerations for the hand surgeon.