Paediatric
Upper limb spasticity
Tone · function and care
What it is
Spasticity is an increase in muscle tone together with a loss of selective control, following an injury to the brain or spinal cord — cerebral palsy, stroke, traumatic brain injury.
In the upper limb the typical posture combines a shoulder turned inward, a bent elbow, a forearm turned palm-down, a flexed wrist and a thumb held in the palm. Over time a posture that was at first flexible can become a fixed contracture, which changes the treatment options entirely.
Symptoms
Stiffness makes it hard to open the hand. Hygiene of the palm and the elbow crease becomes a problem, dressing is laborious, and skin can break down in closed creases.
Where sensation and voluntary control are preserved, the difficulty is more about using the limb in tasks. These two situations — a limb that gets in the way of care, and a limb one wants to use — do not call for the same operations.
Non-operative treatment
Non-operative care remains the mainstay: therapy and stretching, splinting and serial casting, botulinum toxin injections to reduce tone in selected muscles, and oral or intrathecal medication managed with the neurology and rehabilitation team.
Botulinum toxin also has diagnostic value: by reducing tone temporarily, it shows what a surgical lengthening would be likely to achieve.
Surgical treatment
Surgery is considered when a fixed contracture limits function or care. Options include muscle-tendon lengthening or release, tendon transfers to rebalance the wrist and fingers, reconstruction of the thumb held in the palm, and selective neurectomy. Joint fusion is used where a stable, clean position matters more than movement.
Assessing voluntary control and sensation beforehand is decisive: more than the degree of stiffness, it predicts who will gain function.
Recovery expectations
Splinting and therapy continue for several months after surgery, and tone management carries on alongside.
The goal is agreed before the operation and stated plainly: a hand that opens to be washed, a wrist that holds position for grip, an elbow that allows a sleeve to go on. That is the goal the result is measured against.
These pages give general information for patients and referring physicians. They do not replace an individual assessment: the treatment plan is decided in consultation, based on your examination and your goals.