Forearm, Thumb, and Finger Deformities in Cerebral Palsy

Abstract

The hand and forearm deformities in patients with cerebral palsy (CP) may impact functional use or impair custodial care. Treatment goals may differ depending upon the patient and should be explored in detail. Establishing realistic expectations as to what can be achieved with treatment is critical in achieving patient satisfaction with operative outcomes. Two common patient populations that benefit from upper extremity surgery are the child with spastic hemiplegic cerebral palsy and the severely involved child with quadriplegic pattern cerebral palsy. The child with spastic hemiplegic cerebral palsy often has no to mild cognitive impairment. Although they usually can compensate functionally with their uninvolved or minimally involved dominant extremity, the patient and family frequently have goals of improvement in upper extremity appearance and improved assistive use of the hand. Alternatively, the family and child with severe spastic quadriplegia may benefit from increased ease of care in positioning, dressing (especially the ability to maneuver the hand into a sleeve), and hand hygiene. Treatment of the upper extremity may also improve the ability to use a walker or to position the hand to use a joystick electric wheelchair control. Single-stage, multilevel surgical treatment to address all aspects of the arm, forearm, wrist, hand, fingers, and thumb is usually recommended. Surgery is usually not performed in very young children as they may have improved positioning and function with continued developmental maturation. The use of splinting, physical or occupational therapy, constraint induced movement therapy, and botulinum toxin have all been reported and are widely used in the treatment of the upper extremity.