General assessment of the upper limb.

Clinical examination of the upper limb of a spastic patient is a lengthy and somewhat complicated procedure that is best performed together with all the practitioners involved in the child's care. It should be repeated before any decision is made regarding treatment. Standard procedures in surgery of the upper limb in cerebral palsy are not appropriate, as the clinical picture is different for each individual patient. Surgery should be aimed at correcting spasticity, muscle/joint contracture, and motor deficit as required. All these elements therefore must have been assessed carefully before treatment. Finally, clinical examination detects all local and general contraindications to surgery and selects the appropriate candidates.