Surgical Treatment of Spastic "thumb-in-palm" Deformity.

treatment can only be palliative ; and 3) the frequent impairment of the intellectual ability and emotional stability of the patient. The variability of the clinical picture of the spastic hand and the uncertainty in predicting the outcome of surgery necessitate a cautious and individual approach to these problems. Nevertheless surgery can offer a significant improvement in carefully selected cases. The basic deformities in the spastic hand are pronation of the forearm, flexion of the wrist and fingers and flexion-adduction of the thumb. The flexion-adduction contracture of the thumb is a common and severe deformity. The thumb is acutely flexed into the palm and comes to lie under the flexed fingers. The deformity is a compound one and usually combines contracture of the carpo-metacarpal joint in flexion,