Paediatric Surgery (Ukraine). 2026. 2(91): 31-42. doi: 10.15574/PS.2026.2(91).3142
Danilov O. A.¹, Sliepov O. K.², Gorelik V. V.¹, Shulga O. V.^3
1Shupyk National University of Healthcare of Ukraine, Kyiv
²SI «Ukrainian center of maternity and childhood of the NAMS of Ukraine», Kyiv
³MI of the Bila Tserkva City Council «Bila Tserkva Centre for Comprehensive Rehabilitation for Persons with Disabilities "Chance"», Ukraine

For citation: Danilov OA, Sliepov OK, Gorelik VV, Shulga OV. (2026). Surgical correction of spastic hand in children with cerebral palsy. Paediatric Surgery (Ukraine). 2(91): 31–42. doi: 10.15574/PS.2026.2(91).3142.
Article received: Jan 06, 2026. Accepted for publication: Jun 15, 2026.

Spastic hand in children with cerebral palsy is observed in 30-40% of cases, leading to severe disability. Surgical treatment of forearm and hand deformities, in the absence of shoulder joint correction, has a negative impact on hand function.
Aim – to determine the indications for conservative and surgical treatment and its effectiveness in children with cerebral palsy and spastic hand.
Materials and methods. The results obtained from the treatment of 24 patients with cerebral palsy and spastic hand were analyzed. Depending on the severity of the contractures and the treatment methods, two groups were formed: the main group (subgroup A – 10 patients; subgroup B – 7 patients) and the control group (7 patients). Clinical and instrumental diagnostic methods were used.
Results. An improvement in shoulder joint mobility was observed after conservative treatment of patients with grade I contractures. Limited elevation of the upper limb in patients with grade II contractures indicates the need for surgical treatment: restoration of shoulder joint function through release of the pectoralis major and subscapularis muscles. This creates the conditions for restoring not only the motor function of the hand but also stereognosis.
Conclusions. To improve hand function, it is essential to restore upper limb elevation by correcting shoulder joint contractures, taking into account the severity and fibro-dystrophic changes in the muscles: conservative treatment is effective for patients with grade I shoulder joint contractures; surgical correction of spastic hand is most effective for patients with grade II shoulder joint contractures.
The study was conducted in accordance with the principles of the Declaration of Helsinki. Informed consent was obtained from the parents or guardians of the children to conduct the study.
The authors declare that there is no conflict of interest.
Keywords: children, contractures, upper limb, orthopedic surgery.

REFERENCES

1. Bhardwaj P, Sabapathy SR. (2011). Assessment of the hand in cerebral palsy. Indian Journal of Plastic Surgery. 44(2): 348-356. https://doi.org/10.4103/0970-0358.85356; PMid:22022045 PMCid:PMC3193647

2. Chin EM, Gwynn HE, Robinson S, Hoon AH Jr. (2020). Principles of medical and surgical treatment of cerebral palsy. Neurologic Clinics. 38(2): 397-416. https://doi.org/10.1016/j.ncl.2020.01.009; PMid:32279717 PMCid:PMC7158771

3. Chin TYP, Duncan JA, Johnstone BR, Graham HK. (2005). Management of upper limb in cerebral palsy. Journal of Pediatric Orthopaedics. 14(6): 389-404. https://doi.org/10.1097/01202412-200511000-00001; PMid:16200013

4. Danilov O, Shulga O, Kycheruk O, Bandrina K. (2024). Causes of pain in the muscles of the lower extremities in children with cerebral palsy. Orthopaedics, Traumatology and Prosthetics. (3): 41-48. https://doi.org/10.15674/0030-59872024341-48

5. Fedrizzi E, Rosa-Rizzotto M, Turconi AC, Pagliano E et al. (2013). Unimanual and bimanual intensive training in children with hemiplegic cerebral palsy and persistence in time of hand function improvement: 6-month follow-up results of a multisite clinical trial. Journal of Child Neurology. 28(2): 161-175. https://doi.org/10.1177/0883073812443004; PMid:22580904

6. Gschwind CR. (2003). Surgical management of forearm pronation. Journal of Hand Clinics. 19(4): 649-655. https://doi.org/10.1016/S0749-0712(03)00030-1; PMid:14596555

7. Hedberg-Graff J, Granström F, Arner M, Krumlinde-Sundholm L. (2019). Upper-limb contracture development in children with cerebral palsy: A population-based study. Developmental Medicine and Child Neurology. 61(2): 204-211. https://doi.org/10.1111/dmcn.14006; PMid:30203516

8. Hous JH, Gwathmey FW, Fidler MO. (1981). A dynamic approach to the thumb-in palm deformity in cerebral palsy. Journal of Bone and Joint Surgery America. 63(2): 216-225. https://doi.org/10.2106/00004623-198163020-00006

9. Leafblod ND, Van Heest AE. (2015). Management of the spastic wrist and hand in cerebral palsy. Journal of Hand Surgery America. 40(5): 1035-1040. https://doi.org/10.1016/j.jhsa.2014.11.025; PMid:25841769

10. Mikalef P, Power, D. (2018). The rationale of operative treatment for spasticity of the upper limb. MOJ Orthopedics & Rheumatology. 10(3): 300-303. https://doi.org/10.15406/mojor.2018.10.00416

11. Modlesky CM, Zhang C. (2020). Complicated muscle-bone interactions in children with cerebral palsy. Current Osteoporosis Reports. 18: 47-56. https://doi.org/10.1007/s11914-020-00561-y; PMid:32060718 PMCid:PMC8092376

12. Nahm JN, Graham HK, Gormley ME Jr, Georgiadis AG. (2018). Management of hypertonia in cerebral palsy. Current Opinion in Pediatrics. 30(1): 57-64. https://doi.org/10.1097/MOP.0000000000000567; PMid:29135566

13. Patterson JM, Wang AA, Hutchinson DT. (2010). Late deformities following the transfer of the flexor carpi ulnaris to the extensor carpi radialis brevis in children with cerebral palsy. Journal of Hand Surgery America. 35(11): 1774-1778. https://doi.org/10.1016/j.jhsa.2010.07.014; PMid:20888146

14. Ponten E. (2019). Contracture formation in the upper limb in cerebral palsy starts early. Developmental Medicine and Child Neurology. 61(2): 117-118. https://doi.org/10.1111/dmcn.14047; PMid:30246329

15. Rosa-Rizzotto M, Visonà Dalla Pozza L, Corlatti A, Luparia A, Marchi A, Molteni F et al. (2014). The Besta scale for the assessment of observed hand function of children with hemiplegic cerebral palsy: Inter- and intra-rater reliability. European Journal of Physical and Rehabilitation Medicine. 50(5): 543-556.

16. Seruya M, Dickey RM, Fakhro A. (2016). Surgical treatment of pediatric upper limb spasticity: The wrist and hand. Seminars in Plastic Surgery. 30(1): 29-38. https://doi.org/10.1055/s-0035-1571254; PMid:26869861 PMCid:PMC4749375

17. Smeulders M, Coester A, Kreulen M. (2005). Surgical treatment for the thumb-in-palm deformity in patients with cerebral palsy. Cochrane Database of Systematic Reviews. 2005(4): CD004093. https://doi.org/10.1002/14651858.CD004093.pub2; PMid:16235349 PMCid:PMC8763345

18. Sollerman C, Ejeskär A. (1995). Sollerman hand function test: A standardized method and its use in tetraplegic patients. Scandinavian Journal of Plastic and Reconstructive Surgery and Hand Surgery. 29(2): 167-176. https://doi.org/10.3109/02844319509034334; PMid:7569815

19. Taylor N, Sand PL, Jebsen RH. (1983). Evaluation of hand function in children. Archives of Physical Medicine and Rehabilitation. 54(3): 129-135.

20. Van Munster JC, Maathuis CGB, Haga N, Van Eykern L A, Hadders-Algra M. (2009). Does surgical management of the hand in children with unilateral spastic cerebral palsy affect muscle coordination and quality of reaching? Developmental Medicine and Child Neurology. 51(7): 568-570. https://doi.org/10.1111/j.1469-8749.2009.03312.x; PMid:19459912

21. Vuillermin C. (2022). Management of upper extremity manifestations of cerebral palsy. Hand (N Y). 17(3): 416-421. https://doi.org/10.55275/JPOSNA-2022-0042

22. Zancolli EA. (2003). Surgical management of the hand in infantile spastic hemiplegia. Journal of Hand Clinics. 19(4): 609-62. https://doi.org/10.1016/S0749-0712(03)00034-9; PMid:14596553