SURGICAL-MANAGEMENT OF UPPER LIMB DEFORMITIES IN CEREBRAL-PALSY

To correct the most frequent deformity of the spastic hand, muscle release and transfer operations, such as distal slide of hand and finger flexors (according to Scaglietti and Gob), release of the adductor pollicis and flexor pollicis brevis muscle (Matev), and transposition of the flexor carpi ulnaris muscle to the dorsal aspect of the hand, should be performed. These basic operations on the spastic hand can be supplemented by release or transposition of additional muscles of the fingers or hand. Bony procedures should be done to stabilize and augment the grip between thumb and second finger. In selected cases arthrodesis of the wrist can be performed to stabilize the hand in a functional position. The outcome of operations on the spastic hand depends on the application of correct indications as well as on postoperative physiotherapy. A slight functional gain, or even a purely cosmetic improvement, may mean a lot to the patient. In respect of professional rehabilitation of adolescents, operative correction of a deformed hand can help to improve manual skills and thereby increase job chances.