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Semin Plast Surg 2016; 30(01): 029-038
DOI: 10.1055/s-0035-1571254
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Surgical Treatment of Pediatric Upper Limb Spasticity: The Wrist and Hand

Mitchel Seruya
1   Division of Plastic and Maxillofacial Surgery, USC Keck School of Medicine, Los Angeles, California
,
Ryan M. Dickey
2   Division of Plastic Surgery, Baylor College of Medicine, Houston, Texas
,
Abdulla Fakhro
2   Division of Plastic Surgery, Baylor College of Medicine, Houston, Texas
› Author Affiliations
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Publication History

Publication Date:
10 February 2016 (online)

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Abstract

The wrist and hand are essential in the placement of the upper extremity in a functional position for grasp, pinch, and release activities. This depends on the delicate balance between the extrinsic and intrinsic muscles of the wrist and hand. Spasticity alters this equilibrium, limiting the interaction of the upper limb with the environment. Classically, pediatric patients with upper limb spasticity present with a flexed wrist, thumb-in-palm, and flexed finger posture. These contractures are typically secondary to spasticity of the extrinsic flexor muscles of the wrist and hand and intrinsic muscles of the thumb and digits. Tendon release, lengthening, or transfer procedures may help correct the resultant abnormal postures. A total wrist arthrodesis with or without proximal row carpectomy may help address the severely flexed wrist deformity. With proper diagnosis, a well-executed surgical plan, and a consistent hand rehabilitation regimen, successful surgical outcomes can be achieved.

Keywords

spasticity - cerebral palsy - wrist - hand - surgery - tendon lengthening
 

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