الفهرس 
Introduction& aim of studyOnly 14 pages are availabe for public view
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Abstract
Spastic CP is characterized by increasedmuscle tone, increased reflexes andan abnormal pattern of posture and/or movement.
Theclassic appearance is of internal rotation and adductionat the shoulder, flexion of the elbow and wrist, flexionof the fingers and a thumb-in-palm deformity.
The management of the upper limb in CP is often complex. Effective treatment requires a multidisciplinary approach involving paediatricians, occupational therapists, physiotherapists, orthotists and surgeons. Interventions are generally aimed at improving function and cosmesis by spasticity management, preventing contractures and correcting established deformities.
Botulinum toxin A therapy has been shown to relieve spasticity and improve function in the short term.
Occupational therapy and physiotherapy have small treatment effects alone but are essential adjuncts to medical and surgical.
Surgical management of the spastic upper limb in CP requires meticulous evaluationand planning. In addition toevaluation of upper extremity function, consideration should be given to the intelligence and motivation of the patient, and voluntary use of the upperextremity. These are also important details for the patients and their families,who should know that surgery is aimed at improving the upper extremity deformity, and not the primary disorder.
Surgical options for the management of the spastic upper extremityvary with the specific parts, however, they are focusedaround three basic principles: weakening the overactive muscle/tendons, strengthening the underactive muscle/tendons, andstabilizing non-stable joints.
Weakening spastic muscles is the most predictable operative procedure. The muscle tendon unitis weakened by releasing its origin, detaching at the insertion,or lengthening the unit in the midportion, using Z lengthening or fractional lengthening. Releasing the tendon at the originor lengthening at midportion are preferable since they preservesome function, whereas release from the insertion often eliminatesfunction of the muscle.
Strengthening the weak muscles isoften performed using tendon transfers.