Common upper extremity orthopedic surgery
techniques for cerebral palsy include muscle releases or lengthenings and muscle
transfers. These procedures address the soft tissues only. Soft tissues are the
muscles, 
tendons and tissues around the joint capsules.
In lengthenings and
releases, a portion of the muscle near 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. Both of these procedures do not 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 the patient 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 the patient, the patient’s 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, the patient is
back to school or work. 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 given.
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!
