Abstract
Surgery based on an accurate determination of deforming forces, muscle weakness, and joint instability achieves reasonably predictable results in patients with cerebral palsy. Thumb deformities can be classified into those of mainly intrinsic nature, extrinsic nature, and those of a combined nature. This allows identification of which muscles are released most appropriately and which muscle function requires augmentation. Joint instability needs to be taken into consideration because tendon transfers across unstable joints will be ineffective. The various surgical procedures are outlined in the text. In 32 patients, application of these principles and techniques allowed removal of the thumb from the palm in 29 patients during fist formation. Lateral pinch was established in 26 thumbs, and functional assessment revealed improvement in one functional grade. Functional benefit may be determined by other factors beyond the control of the surgeon. Therefore, the decision to proceed to surgery may be undertaken only after detailed and repeated clinical examinations are conducted that are coordinated with the assessments of parents, caregivers, physicians, occupational and physical therapists, and social counselors.
References
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Citations
Jun 20, 2006·Techniques in Hand & Upper Extremity Surgery·Ignacio ProubastaJoan Itarte
Nov 29, 2011·Hand Clinics·Jack Choueka, Susan Craig Scott
May 20, 2011·Chirurgie de la main·Y Allieu
Mar 26, 2011·Developmental Medicine and Child Neurology·Karen McConnellClaire Kerr
Jul 9, 2016·Hand Clinics·Anchal BansalCharles A Goldfarb
Apr 22, 2006·Techniques in Hand & Upper Extremity Surgery·Ignacio Proubasta
Aug 5, 2017·The Journal of Hand Surgery Asian-Pacific Volume·García Luis-Alejandro, Gómez Bárbara
Jul 12, 2008·American Journal of Physical Medicine & Rehabilitation·Sun ImHye Won Kim
Jan 13, 2015·Journal of Pediatric Orthopedics·Juul V AlewijnseMick Kreulen