Difficult conditions of the spastic upper limb

“Difficult” is a very relative terminology and “difficult” to generalize. The various operative procedures done in patients with spastic hand are not technically demanding but assessing and decision making is the real challenge in these patients. There are some difficulties, which I personally encounter while assessing these patients and they have a bearing on the decision making. There are some other challenges which are characteristic of the disease, which are not correctable and they remain “difficult”. Some uncommon presentations can at times pose ‘difficulty’. We can divide the difficult conditions into three categories: