Shoulder and Elbow Problems in Cerebral Palsy

Abstract

Shoulder and elbow problems in children with cerebral palsy are often an associated problem of more general issues. For those children who are able to walk, Gross Motor Function Classification System (GMFCS) I, II, and III, the shoulder motions are often a compensation for balance or for assistance with gait. At this time there is no evidence that direct intervention on the movement of the elbow and shoulder impacts the pathologic gait. Children with hemiplegic pattern cerebral palsy have received a lot of attention for the typical plegic posturing the limb develops. The impact of this posturing has both a cosmetic effect and a functional impact on the ability to utilize the extremity. The functional impact can be surgically addressed by placing the limb in a better position. This hemiplegic posture gradually improves toward a more normal posture through adolescence as a natural part of development. For children who are not ambulatory, GMFCS IV and V, the primary shoulder problems are usually related to activities of daily living. Many of these children develop contractures of the shoulders that make care such as bathing and dressing difficult. These contractures can be addressed through various means; however, they may require surgical attention. There are also children who developed severe contractures in external or internal