Upper limbs

Shoulder injury, subluxation and dislocation may occur in adults with cerebral palsy. Shoulder injury may be exacerbated by wheelchair use. Pain or loss of function in upper limbs may have a major effect on:

• independence in personal care
• mobility (particularly for people who use a wheelchair)
• communication (particularly for people who use communication aids).

Assessment and management should be performed by a multidisciplinary team, including a physiotherapist and an occupational therapist with expertise in this area. A rehabilitation physician can advise on appropriate management, or refer to a musculoskeletal specialist or orthopaedic surgeon.

Surgical procedures (eg tenotomies, tendon transplants) are performed to improve and maintain function of the upper limbs. These are more commonly performed in children, and adults with severe and limiting contractures.