Download PDF
Semin Plast Surg 2016; 30(01): 045-050
DOI: 10.1055/s-0035-1571253
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Surgical Treatment of Pediatric Upper Limb Spasticity: The Shoulder

Mitchel Seruya
1   Division of Plastic and Maxillofacial Surgery, USC Keck School of Medicine, Children's Hospital Los Angeles, Los Angeles, California
,
Joshua D. Johnson
2   Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
› Author Affiliations
Further Information

Publication History

Publication Date:
10 February 2016 (online)

    Permissions and Reprints

Abstract

The shoulder joint is essential for placing the hand in a functional position for reach and overhead activities. This depends on the delicate balance between abductor/adductor and internal/external rotator muscles. Spasticity alters this equilibrium, limiting the interaction of the upper limb with the environment. Classically, pediatric patients with upper limb spasticity present with an adduction and internal rotation contracture of the shoulder. These contractures are typically secondary to spasticity of the pectoralis major and subscapularis muscles and sometimes attributed to the latissimus dorsi muscle. Fractional lengthening, Z-step lengthening, or tendon release of the contributing muscle groups may help correct the adduction and internal rotation contractures. With proper diagnosis, a well-executed surgical plan, and a consistent hand rehabilitation regimen, successful surgical outcomes can be achieved.

Keywords

spasticity - cerebral palsy - shoulder - surgery - tendon lengthening
 

  • References

  • 1 Van Heest AE, House JH, Cariello C. Upper extremity surgical treatment of cerebral palsy. J Hand Surg Am 1999; 24 (2) 323-330
    CrossrefPubMedGoogle Scholar
  • 2 Carlson MG, Athwal GS, Bueno RA. Treatment of the wrist and hand in cerebral palsy. J Hand Surg Am 2006; 31 (3) 483-490
    CrossrefPubMedGoogle Scholar
  • 3 Carroll RE. The surgical treatment of cerebral palsy. I. The upper extremity. Surg Clin North Am 1950; 31 (2) 385-390
    PubMedGoogle Scholar
  • 4 Hoffer MM. The use of the pathokinesiology laboratory to select muscles for tendon transfers in the cerebral palsy hand. Clin Orthop Relat Res 1993; 288 (288) 135-138
    PubMedGoogle Scholar
  • 5 Chin TY, Duncan JA, Johnstone BR, Graham HK. Management of the upper limb in cerebral palsy. J Pediatr Orthop B 2005; 14 (6) 389-404
    CrossrefPubMedGoogle Scholar
  • 6 Domzalski M, Inan M, Littleton AG, Miller F. Pectoralis major release to improve shoulder abduction in children with cerebral palsy. J Pediatr Orthop 2007; 27 (4) 457-461
    CrossrefPubMedGoogle Scholar
  • 7 Carlson MG. Cerebral palsy. In: Wolfe SW, Hotchkiss RN, Pederson WC, Kozin SH, , eds. Green's Operative Hand Surgery. 6th ed. Philadelphia, PA: Elsevier; 2010: 1139-1172
    Google Scholar
  • 8 Namdari S, Alosh H, Baldwin K, Mehta S, Keenan MA. Outcomes of tendon fractional lengthenings to improve shoulder function in patients with spastic hemiparesis. J Shoulder Elbow Surg 2012; 21 (5) 691-698
    CrossrefPubMedGoogle Scholar