Cerebral Palsy

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.

Cerebral Palsy Symptoms and Diagnosis

Some of the most common symptoms of cerebral palsy in the upper extremity include:


  • Stiff and curled fingers
  • Stiff thumb that does not move from the palm
  • Stiff and bent wrist with palm facing down
  • Stiff and bent elbow that
  • Limited voluntary control of fingers, wrist, and elbow

Most patients have disease that leads to a classic posture of bent elbow, wrist, and curled fingers. In some cases the spasticity can be limited to only some areas.

Patients with cerebral palsy typically already have been diagnosed at the time of birth or shortly thereafter. When they present to the Hand Surgeon, their hand deficits are diagnosed by physical exam alone most of the time. In some cases EMG and nerve studies may be obtained to further assist in planning of future surgeries and assess voluntary muscle control.

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 Treatment Options

Treatment of spasticity form cerebral palsy is complex and requires the work of neurologists, pediatricians, therapists, and hand specialists. The initial part of the treatment is therapy and splints to ensure the joints remain loose and do not freeze from the long standing spasticity. The neurologist may also prescribe oral medications or botox injections to reduce the spasticity of the muscles.
Surgery focuses on two strategies: weakening spastic muscles, and tendon transfers to strengthen the muscles that oppose the spastic muscles. The goal of the procedures it to reduce the effect of spasticity, increase voluntary control, and increase the function of the hand.

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.


Procedures for cerebral palsy may require inpatient admission or overnight observation. In some cases they can be done in an outpatient setting depending on the overall health of the patient. Recovery is variable and depends on the areas treated and type of procedure. Most of these procedures achieve recovery in 2 weeks, but there is need for therapy for at least 3-6 months after the operation.

Wound healing is typically complete in 1-2 weeks after the procedure. Return to work or activities depends on the procedure performed and is discussed at the time of the visit.

Why Choose Precision Hand Center for your Cerebral Palsy Procedure?

Dr. Rueda, a Hand Fellowship trained surgeon who has 7 years and 2,000 procedures of experience will be your safe and best choice for treatment of upper extremity cerebral palsy. Successful results in this procedure requires a surgeon that is experienced and knowledgeable in hand surgery and hand anatomy. Dr. Rueda has published articles in expert peer reviewed journals and his work has been presented in several national conferences. Dr. Rueda’s passion for patient education and custom centered approach will guarantee you feel comfortable every step of the way. Dr. Rueda also believes in treating his patients as if he was treating his own family; you can trust you will enter a trusting and long-term relationship and have some of the best upper extremity cerebral palsy treatment Palm Beach can offer.


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. 

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