Dr. Steven Rueda is one of the most sought after hand doctors for the treatment of upper extremity cerebral palsy in Palm Beach. Patients with cerebral palsy suffer from spasticity of the muscles that limits their ability to control their hand. Cerebral palsy can also severely affect the elbow and forearm function. The disease can be limited to mild spasticity, but in some cases the spasticity is severe enough to eliminate any function of the arm and hand. Treatment of this condition requires a team including neurologists, pediatricians, and hand specialists.
WHAT CAUSES CEREBRAL PALSY?
The spasticity seen in patients with cerebral palsy is caused by damaged to the portion of the brain or spinal cord that controls voluntary muscle movement. This leads to increased involuntary activity in some muscles, leading to the typical postures seen in these patients. Some of these postures include: wrist flexion, forearm pronation, clenched thumbs and fingers. In some cases the posture can lead to difficulty in hygiene and skin breakdown.
CEREBRAL PALSY PROCEDURE
Weakening of spastic muscles is usually achieved by lengthening the muscles’ tendon. The tendons start at the muscle and attach to bone. When the tendons are lengthened the muscles loosens some of its tension and reliefs the spasticity. Muscles can also be weakened by loosening their origin on bone so that they are not as tight.
Tendon transfer is a procedure in which a tendon with good function and strength is moved to another tendon that is weak or has no function. In cerebral palsy, the tendons are transferred to strengthen the muscles that are “opposing” or “fighting” against the strong spastic muscles affected by the disease. This allows the patient to retain some voluntary control of the arm.
In severe cases where tendon transfers and muscle weakening will not work, it may be necessary to use plates and screws to maintain a good joint position. In cerebral palsy this is frequently accomplished with a wrist fusion.
FREQUENTLY ASKED QUESTIONS (FAQ)
Candidates for cerebral palsy hand surgery have to meet strict criteria. They must demonstrate voluntary control of their muscles if they are candidate for tendon transfers; this is assessed with a combination of physical examination and EMG. Salvage procedures are availble for those who suffer from severe spasticity, have difficulty with hygiene, and have no voluntary control. The latter are candidates for procedures like wrist fusion and tendon transfers with limited functional goals.