Upper limb
Indications for surgery
Spastic hemiplegia
- have voluntary grasp and release
Spastic quadriplegia
- many patients have sensory neglect for affected limbs
- won't use limb post surgery regardless
- may need some releases for hygiene / dressing
Thumb in Palm Deformity
| Etiology | Management |
|---|---|
|
Weak EPL Tight FPL Webspace contracture |
Z lengthen FPL Release webspace contractures Reinforce EPL with FCR / brachioradialis
|
Flexed fingers with Swan neck deformity
| Etiology | Management |
|---|---|
|
Spastic FDS / FDP Spastic intrinsics
|
FDS tenodesis |
Flexed and pronated wrist
Issues
| Etiology | Management |
|---|---|
|
Spastic wrist and finger flexors Weakness wrist extensors |
Common flexor origin slide FCU +/- FCR transfers
Wrist fusion |
Elbow contractures
Issues
Difficulty with wheelchair and crutches
Fixed supination from biceps can causes painful radial head subluxation
| Etiology | Management > 40° |
|---|---|
|
Biceps contractures Brachialis contractures Flexion - Pronator contractures
|
Distal biceps tendon Z lengthen Brachialis release Common flexor origin release |
Vumedi biceps tendon z lengthening CP technique video
Shoulder internal rotation and adduction
Issues
Difficulties putting on clothing
Posterior shoulder subluxation
| Etiology | Management |
|---|---|
|
Contractures subscapularis Contracture pectoralis major |
Subscapularis release Pectoralis major release Teres major release
|