Main de l'hémiplégique

The hemiplegic hand is a spastic and paralytic hand due to central neurological lesions. Two completely different types must be distinguished: the hand of the child with cerebral palsy which is the subject of almost all the studies on surgery of the hemiplegic hand, and the hand of the brain damaged adult (after vascular hemiplegia or brain traumatism). In this second type, the indications in a functional aim are very rare, due to the associated cerebral disorders. However, the indications in a hygienic or aesthetic aim are common and make this surgery, which is not very well known and which can greatly improve the global functions of these patients, a winning surgery. The surgical indications are based on a specific clinical study of the hand completed by the use of anaesthetic blocks, electromyographic studies and use of botox. Apart from this lesional study, they must take into consideration general and cognitive conditions. It is thus possible to distinguish two types of hands: the “Potentially Functional Hand” which can recover after treatment its functional possibilities which will never be total but will be useful, and the “Potentially Non Functional Hand” which will remain functionally unusable. The aim of this surgery is to correct muscular disorders between agonist and antagonist and the osteo-articular deformations that they bring about. For this, the nerve can be treated (hyponeurotisation, neurectomy, neuro-surgery) or on the muscle by relaxing the agonist muscles (muscular disinsertion, tendon lengthening…) or by strengthening the action of the antagonist muscles by tendon transfers. The articular stabilisation of the wrist, of the digital chains and of the thumb in a good position can be performed by arthrodesis or tenodesis.