Treatment of severe rigid contractures of cerebral palsied upper limbs

Flexion contractures caused by cerebral palsy in adult patients can become so rigid and so severe that skin breakdown and infection on the flexor surfaces of the palm and elbow can result. In 11 such patients we have utilized tendon resections, ray amputations, elbow resection arthroplasties and other techniques to correct deformities. Because improvement of hygiene and not functional rehabilitation was the goal in these patients, these aggressive measures could be utilized more freely than usual without fear of jeopardizing the patient's ability to use the hand post-operatively. Treatment of combined intrinsic and extrinsic contracture usually required resection of the sublimi and metacarpal head resection. Thumb-in-palm deformities were difficult to correct and required osteotomies of the first metacarpal or greater multangular resection. Elbow resection was useful in correcting flexion deformities of that joint but deformity recurred unless the biceps tendon was released as part of the procedure.