Assessment of the hand in cerebral palsy
31 December 2019 (online)
Cerebral palsy is the musculoskeletal manifestation of a nonprogressive central nervous system lesion that usually occurs due to a perinatal insult to the brain. Though the cerebral insult is static the musculoskeletal pathology is progressive. Some patients with cerebral palsy whose hands are affected can be made better by surgery. The surgical procedures as such are not very technically demanding but the assessment, decision-making, and selecting the procedures for the given patient make this field challenging. When done well, the results are rewarding not only in terms of improvement in hand function but also in appearance and personal hygiene, which leads to better self-image and permits better acceptance in the society. This article focuses on the clinical examination, patient selection, and decision-making while managing these patients.
- 1 Graham HK, Selber P. Musculoskeletal aspects of cerebral palsy. J Bone Joint Surg Br 2003;85:157-66.
- 2 Herring JA. Disorders of brain. In: Tachdjian’s Pediatric Orthopaedic. 4th ed. Philadelphia: Saunders; 2008. p. 1275-404.
- 3 Zancolli E. Structural and dynamic bases of hand surgery. 2nd ed. Philadelphia: Lippincott; 1979. p. 263-83.
- 4 Carlson MG. Green’s operative hand surgery. In: Green DP, Hotchkiss RN, Pederson WC, Wolfe SW, editors. Cerebral palsy. 5th ed. Philadelphia: Churchill Livingstone; 2005. p. 1197-234.
- 5 Leclercq C. General assessment of the upper limb. Hand Clin 2003;19:557-64.
- 6 McConnell K, Johnston L, Kerr C. Upper limb function and deformity in cerebral palsy: A review of classification systems. Dev Med Child Neurol 2011;53:799-805.
- 7 House JH, Gwathmey FW, Fidler MO. A dynamic approach to the thumb-in-palm deformity in cerebral palsy: Evaluation and results in fifty-six patients. J Bone Joint Surg Am 1981;63:216-25.
- 8 Green WT, Banks HH. Flexor carpi ulnaris transplant and its use in cerebral palsy. J Bone Joint Surg Am 1962;44:1343-52.
- 9 Samilson RL, Morris JM. Surgical improvement of the cerebral-palsied upper limb: Electromyographic studies and results of 128 operations. J Bone Joint Surg Am 1964;46:1203-16.
- 10 Miller F. Cerebral palsy. 1st ed. Wilmington (USA): Springer Publishers; 2005.
- 11 Manske PR. Cerebral palsy of the upper extremity. Hand Clin 1990;6:697-709.
- 12 Samilson RL. Principles of assessment of the upper limb in cerebral palsy. Clin Orthop Relat Res 1966;47:105-25.
- 13 Goldner JL. Upper extremity surgical procedures for patients with cerebral palsy. Instr Course Lect 1979;28:37-66.
- 14 Van Heest AE, House JH, Cariello C. Upper extremity surgical treatment of cerebral palsy. J Hand Surg Am 1999;24:323-30.
- 15 Tonkin MA. The growing hand. In: Gupta A, Kay SPJ, Scheker LR, editors. The upper limb in cerebral palsy. London: Mosby; 2000. p. 447-59.
- 16 Van Heest EA, House J, Putnam M. Sensibility deficiencies in the hands of children with spastic hemiplegia. J Hand Surg Am 1993;18:278-81.
- 17 Carlson MG, Brooks C. The effect of altered hand position and motor skills on stereognosis. J Hand Surg Am 2009;34:896-9.
- 18 Hoffer MM. The upper extremity in cerebral palsy. AAOS Instructional Course Lecture. St Louis: Mosby; 1979. p. 133-7.
- 19 Tonkin M. The upper limb in cerebral palsy. Curr Orthop 1995;9:149-55.
- 20 Gschwind C, Tonkin M. Surgery for cerebral palsy: Part 1: Classification and operative procedures for pronation deformity. J Hand Surg Br 1992;17:391-5.
- 21 Zancolli E. Structural and dynamic bases of hand surgery. Pathology of the extensor apparatus of the finger: 2nd ed. Philadelphia: Lippincott; 1979. p. 64-104.
- 22 Carlson MG, Gallagher K, Spirtos M. Surgical treatment of swan neck deformity in hemiplegic cerebral palsy. J Hand Surg Am 2007;32:1418-22.
- 23 Swanson AB. Surgery of the hand in cerebral palsy and swan neck deformity. J Bone Joint Surg Am 1960;42:951-64.
- 24 Tonkin MA, Hughes J, Smith KL. Lateral band translocation for swan neck deformity. J Hand Surg Am 1992;17:260-7.
- 25 Sakellarides HT, Mital MA, Matza RA, Dimakopoulos P. Classification and surgical treatment of the thumb-in-palm deformity in cerebral palsy and spastic paralysis. J Hand Surg Am 1995;20:428-31.
- 26 Tonkin MA. Surgery for Cerebral palsy part 3: Classification and operative procedures for thumb deformity. J Hand Surg Br 2001;26:465-70.
- 27 Goldner JL. Upper extremity tendon transfers in cerebral palsy. Orthop Clin N Am 1974;5:389-414.
- 28 Manske PR. Redirecting of extensor pollicis longus in the treatment of spastic thumb-in-palm deformity. J Hand Surg Am 1985;10:553-60.
- 29 Zancolli EA, Zancolli E Jr. Surgical rehabilitation of the spastic upper limb in cerebral palsy. In: Lamb DW, editor. The paralyzed hand. Edinburgh: Churchill Livingstone; 1987. p. 153-68.