Surgical management of wrist and finger deformity

The surgical results of upper extremity intervention have been shown to improve hand function from paperweight/passive assist function to active assist function [20]. Although children with cerebral palsy commonly have a sensibility deficiency in conjunction with their motor deficiency [36,37], several recent studies have disproved the previous doctrine that hand surgery should not be performed on children with sensibility deficiencies. The author's report [20] of 134 children treated surgically showed that preoperatively 50% had impaired two-point discrimination and 75% had impaired stereognosis; impaired sensibility had no adverse effect on surgical results. Eliasson et al [18] reported on 32 children treated surgically with tendon transfers and muscle releases. Impaired sensibility before the surgery did not influence the outcome. In fact, Dahlin et al [38] reported 36 patients treated operatively and followed for 18 months, finding an improvement in stereognosis function associated with the improvement in their motor function, presumably because of improved functional use. Children with cerebral palsy can improve their motor function and perhaps also their sensibility function with appropriately planned and executed tendon release and transfer surgery. Balance of the wrist and fingers is the key element in improvement of upper limb function.