title: [Surgical possibilities in spastic paralysis of arm and hand].
abstract: OBJECTIVE
  To determine the results of surgical correction of spastic paralysis of the hand due to cerebral palsy.
  
  
  METHODS
  Descriptive.
  
  
  METHODS
  Academic Medical Centre, Amsterdam, the Netherlands, and rehabilitation centre De Trappenberg.
  
  
  METHODS
  From 1-1-1990 until 1-6-1994 twenty patients with spastic upper limb in cerebral palsy were operated in our hospital. They were all seen preoperatively by our multidisciplinary team, and selected according to the Zancolli classification. Seventeen operations were aimed at improving hand function, the other three were performed for contractures or for cosmetic/hygienic reasons. Surgery was aimed at correcting the muscular imbalance, by weakening spastic muscles via tenotomy or lengthening and by reinforcing paralysed muscles via tendon transfer or rerouting. Often stabilisation of joints by tenodesis, capsulodesis or arthrodesis was necessary as well.
  
  
  RESULTS
  Eighteen of the twenty patients were (very) happy with the results. In two patients there was no functional gain. Only once was a postoperative complication seen: pseudarthrosis of the first carpometacarpal joint. This was corrected successfully by rearthrodesis. We found we were able to predict the functional outcome fairly accurately.
  
  
  CONCLUSIONS
  With accurate patient selection, surgical intervention in patients with cerebral palsy may restore hand function adequately and predictably.
authors.affiliation: Afd. Revalidatie, Academisch Medisch Centrum, Amsterdam.
authors.forename: A F
authors.initials: AF
authors.lastname: Hoeksma
authors.forename: K E
authors.initials: KE
authors.lastname: Bos
authors.forename: A
authors.initials: A
authors.lastname: Meester-Delver
mesh_terms: D000203:Activities of Daily Living; D000293:Adolescent; D000328:Adult; D001174:Arthrodesis; D002547:Cerebral Palsy / Q000150:complications*; D002648:Child; D002675:Child, Preschool; D003286:Contracture / Q000601:surgery; D005260:Female; D006227:Hand Deformities, Acquired / Q000601:surgery*; D006801:Humans; D008297:Male; D009128:Muscle Spasticity / Q000534:rehabilitation / Q000601:surgery*; D012086:Reoperation
vernacular_title: Operatieve mogelijkheden bij spastisch verlamde arm en hand.