Spécificités de l'examen neuro-orthopédique et de la chirurgie du membre supérieur spastique de l'adulte

Deformities of the hand may occur following central nervous system disorders cerebral palsy, despite medical treatment, regular follow-up visits, and rehabilitation. Spasticity, along with impairments of motor and sensory function and coordination, can lead to contractures of the extrinsic and/or intrinsic muscles of the wrist and hand, resulting in complex deformities and loss of function. It is often difficult to estimate the functional potential as it usually depends on the motor capacity of antagonist muscles, which can be masked by spasticity and the deformities. Because these patients have multifactorial and complex problems, it is very important to carry out a precise assessment of the neurological and orthopaedic status and functional potential as well as the goals that the patient desires from surgical treatment. In patients with cerebral palsy, it is sometimes difficult to assess the degree of active muscle control present, because it is masked by the forearm, wrist, and finger deformations. Consequently, a hygienic and aesthetic goal or a functional goal might be determined.