RECONSTRUCTIVE SURGERY OF THE HAND IN CEREBRAL PALSY AND SPASTIC PARALYSIS RESULTING FROM INJURY TO THE SPINAL CORD

¹ Duke Hospital, Duke University School of Medicine, Durham

1. In cerebral-palsy patients, the majority of deformities about the hand cannot be aided by surgery. The prognosis is somewhat better for surgical procedures in those patients who have had an injury of the cervical cord with resulting spasticity of the hands. Spastic hands which are reasonably good from the outset can be improved by stretching, splinting, and re-education; those which lack a major muscle group or which have a specific deformity may, in some instances, be aided by surgery. The operative procedures are selective. Preliminary observation and study are essential. The end result is never a cure, but only an improvement in the ability to learn specific functions. Even though the better hand, or normal hand if present, will be used for most activities, the surgical procedures can give the patient a "helping hand", which will increase his independence.

2. Selective tenotomies and tendon transfers can improve function of the hand in certain patients with cerebral palsy or with spasticity resulting from trauma to the cervical cord. However, even with a carefully chosen and well executed program, failures will occur.

3. Tendon surgery, if indicated, is done as the initial procedure and is followed when necessary by joint arthrodesis. Arthrodesis of the metacarpophalangeal joint of the thumb is a useful procedure. The position of the wrist for arthrodesis should be determined carefully prior to the definitive operation. Neurectomies of the forearm or hand musculature have not been done in this group of patients.

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