Spasticity

Cerebral palsy and traumatic brain injury are upper motor neuron central nervous system diseases that result in decreased function, muscle imbalances, and malpositioning of the upper limb. Cerebral palsy is an irreversible and nonprogressive brain injury. Traumatic brain injury (TBI) is a leading cause of disability and death in the United States, and an estimated 1.5 million Americans sustain a traumatic brain injury annually with about 50,000 of these people dying. Treatment of the spastic limb in patients with cerebral palsy and traumatic brain injury starts with therapeutic modalities and progresses to pharmacologic management and/or surgical procedures. This team approach provides optimum care to these patients as long as there is communication among the teams to avoid fragmentation of care. The surgical techniques performed fall into four main categories: (1) soft tissue releases (tendon lengthening, myotomy); (2) tendon transfer; (3) bone or joint (osteotomy, fusion); and (4) neurectomy (selective and hyperselective). This chapter will detail the surgical procedures about the shoulder, elbow, forearm, wrist, and hand to maximize function and independence.