Surgical Treatment

Operative or surgical treatment for upper limb cerebral palsy (CP) in children is considered when conservative therapies, such as physical therapy, occupational therapy, medications, and assistive devices, have not provided sufficient improvement in function or when there are severe deformities or contractures that significantly affect the child's daily life. 

Surgical interventions aim to improve upper limb function, reduce spasticity, correct deformities, and enhance overall quality of life. The specific surgical procedures chosen depend on the child's individual needs and the severity of their upper limb involvement. Some common operative treatments for upper limb CP in children include:

• Tendon Lengthening or Release: In this procedure, tight or shortened tendons are surgically lengthened or released to improve joint mobility. This can help address contractures and spasticity and allow for a greater range of motion in the affected upper limb.

• Tendon Transfers:  Tendon transfers involve moving tendons from one location to another to improve function and to rebalance joints. 

• Bony Procedures: Various bony orthopedic procedures may be performed to correct joint deformities, such as arthrodesis (joint fusion) to stabilize joints, or derotational osteotomies. Osteotomies involve cutting and reshaping bones to improve joint alignment and function. 

• Highly Selective Neurectomy: This procedure reduces spasticity by cutting some of the  motor nerves to the spastic muscles. This reduces the muscle spasticity but doesn't cause any significant weakness. 

• Selective Dorsal Rhizotomy (SDR): SDR is a complex neurosurgical procedure in which specific nerve roots in the spinal cord are selectively cut. It more commonly performed to reduce spasticity in the lower limbs. Whilst not mainstream its use in the upper limbs to improve overall motor function has been reported.

Each child's case is unique, and the choice of surgical procedures should be based on a comprehensive assessment of their specific needs, goals, and overall health. The ultimate goal of surgical intervention is to improve the child's upper limb function, reduce pain and discomfort, and enhance their overall quality of life.