Hand activity problem in cerebral palsy (HAND DEFORMITY)

Problem: Common problem in upper limb is pronation deformity, spasticity of finger & wrist flexor, weakness of wrist / finger extensor, flexor spasticity at elbow.

Management Protocol: Hand affection in early age is managed by physiotherapy, training in fine motor activity, sensory modulation & brace. Most of the time persistent sensory problem interferes in getting good outcome. Botulinum toxin is required in severe spasticity. But when the deformity becomes fixed, then they need surgical intervention in the form of aponeurotic release of long musculo-tendinous unit. Tendon transfer is used to supplement function of weaker muscle. Common tendon transfer for pronation deformity is rerouting of pronater teres & transfer of Flexor Carpi Ulnaris to Extensor Carpi Radialis Brevis for weak wrist extensor & Flexor Carpi Ulnaris to Extensor digitorum Commines for finger extension. Functional deficit in the hands requires good therapeutic modality including CIMT, Mirror therapy, Fine motor activity and sensory modulation.

Authors

Written by Dr. Jitendra Kumar Jain

MS Ortho (PGI Chandigarh) & DNB Ortho, Senior Paediatric Orthopaedic Surgeon, Chairman of Trishla Foundation, India Experience of 20 years in children with orthopaedic problems, cerebral palsy & congenital limb deficiency. Manage more than 1 Lac children with Cerebral Palsy & orthopaedic problem. Member of different Government & non-government organizations. Cerebral palsy children from every state of India & 20 countries are visiting him for expert opinions.

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Reviewed by Dr Varidmala Jain

MBBS, MD (Community Medicine), PhD Public Health Secretary, Trishla Foundation, 15 years experience in counselling & guidance to parents of children with cerebral palsy

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Dr Jitendra Kumar Jain

Founder of Trishla Foundation

MBBS, DNB Ortho, MS Ortho, Paediatric orthopedic surgeon

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