Children and Adolescent Hand and Arm (CHArm) Center

Surgery

Common upper extremity orthopedic surgical techniques for cerebral palsy include muscle releases, lengthenings, and muscle transfers. These procedures address the soft tissues only, which include the muscles, tendons, and tissues around the joint capsules.

In lengthenings and releases, a portion of the muscle close to where it attaches to the bone is surgically cut to loosen it. In a muscle transfer, one end of a muscle is surgically cut and moved to an area nearby in order to change the direction of its pull. Neither of these procedures prevent future medical advances from being implemented, and both are relatively reversible.

If an area around a joint capsule is addressed (often in the fingers and thumb), a small wire may be placed in the joint space to help secure the joint while your child is healing. It comes out when the dressing is removed. In very extreme cases, where the hand position is very compromised, work on the bone may be done. This is not very common and is only done on adults with severe involvement, as it is not reversible.

The anesthesia plan differs with each patient and can vary from general anesthesia to local anesthesia with sedation. The type of surgery planned, the age of your child, his or her general medical status, and the family preferences all play a role in deciding the anesthesia plan. Patients and family members should have an opportunity to speak with the attending anesthesiologist to learn the pros and cons of each situation.

Most patients stay over in the hospital one night and some even go home the same day. After surgery, the arm and hand is placed in a half cast with a bulky dressing. Most patients are discharged with a simple pain reliever prescription. Ice and elevation help to keep the arm comfortable.

Within a few days, your child is ready to return to school. The dressing needs to stay dry for the next four weeks. The hard work begins four weeks after surgery when the bulky dressing comes off. This is usually an exciting but overwhelming day. The dressing is taken off, pins are removed, a plastic splint needs to be made, and exercises are performed. Many of the children, as well as their parents, are nervous. It is a big day, and anxiety is normal. The good news is that the real gains now start to take place during the post-operative period!

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