Upper Extremity Operative Procedures in Cerebral Palsy

Abstract

Upper extremity procedures in children with cerebral palsy are usually performed utilizing the concept of single-event multilevel surgery (SEMLS). Utilizing the SEMLS concept, a detailed and full evaluation of the upper extremity should be performed including a careful listing of the goals of the patient and the family. A detailed physical examination to evaluate the presence of movement disorders, increased spasticity, muscle contractures, and unstable joints is also performed. There is also an evaluation of the strength of muscles, voluntary motor control, and the motivation of the patient to participate in rehabilitation. Most children also benefit from a detailed video analysis utilizing a structured tool such as the Shriners Upper Extremity Evaluation (SHUEE). In addition there should be a patient-reported documentation such as the Pediatric Outcomes Data Collection Instrument (PODCI) or the Pediatric Quality of Life instrument (PedsQL). Although many children require multiple procedures in a single upper extremity at the same time, there are also indications for performing a single procedure when that is the only relevant complaint. This is a surgical atlas with detailed surgical procedure explanations for shoulder, elbow, wrist, finger, and thumb corrections. This is a surgical atlas description of step-by-step surgical techniques.