Cerebral palsy of the upper extremity.

The care of patients with spastic cerebral palsy requires the dedicated attention of a surgeon who is interested in the upper extremity, in association with therapists and other medical personnel who have a similar interest. The difficult problems of the upper extremity have often been overlooked by concerns related to the other skeletal manifestations in the spine and lower extremities. However, a pessimistic view of surgical results in the upper extremity is unwarranted, as even small gains in severely affected patients often result in an improved life. The surgical concepts related to this complex neurologic problem must be kept rather simple, and include principally the release of spastic deforming muscles, and, secondly, the use of augmentation tendon transfers to maintain an improved functional position. In order to allow the augmentation tendon transfers to function with minimal postoperative muscle re-education, tendon transfers that use muscles that contribute to the deformity are preferred; in the transferred position, these will function to correct the deformity and fire in phase without extensive postoperative training. Such muscle transfers are usually available to correct the more common pattern of spastic deformities. The most important aspect of surgical planning is to determine whether or not the individual is attempting to voluntarily use the upper extremity. In such cases, surgical procedures can reposition the deformed limb and enable the individual to function more effectively. On the other hand, it is most important to realize that an operative procedure will not stimulate an individual to begin to use a previously functionless limb.