Surgery is ideally performed to improve function of the upper limb, and thus allow the hand to reach, to grasp, to manipulate, and to release. This functional surgery usually involves several procedures, in order to decrease the tone of the muscles which are hyperactive or contracted, and to reinforce the muscles which are weak or paralysed.
But this may not be possible in patients with severe impairments, such as severe paralysis, abnormal movements, bed confined patients, severe communication (cognition*) problems. In some cases, surgery will be helpful to correct a deformity in order to facilitate nursing or hygiene, sometimes in order to decrease pain. Some patients only wish for a cosmetic improvement (correction of a severely flexed elbow, or wrist).
Three main types of procedures are used at surgery, in isolation or associated:
