Children with hand or arm problems related to cerebral palsy can find support at Children’s Hospital of Philadelphia (CHOP). Our pediatric arm and hand specialists take a multidisciplinary approach to evaluating and treating these conditions, with the goal of helping patients to improve function, comfort and independence.

What is a cerebral palsy upper extremity disorder?

Children with cerebral palsy may experience challenges using their arms or hands because of muscle tone, strength, coordination and joint alignment. 

Arm and hand disorders vary widely in children with cerebral palsy. They often affect the ability to reach, grasp, manipulate objects and perform everyday activities such as dressing, feeding, writing and play. Some children may have mild difficulty with fine motor tasks, while others may have more significant limitations affecting one or both arms and hands.

Sometimes arm and hand disorders affect a child’s ability to perform tasks independently. They can also affect a caregivers’ ability to care for a child.

What causes arm and hand problems in children with cerebral palsy?

Cerebral palsy, caused by injury to the developing brain, affects how muscles are controlled. 

In the arms and hands of children with cerebral palsy, this can sometimes lead to: 

• Increased muscle tone (spasticity), often making them feel extra tight or hard to stretch.
• Muscles that are weak or don’t work as well as they can (imbalance).
• Difficulty moving one part of the body without other parts joining in (limited selective motor control).
• Trouble feeling where the body is in space or sensing certain movements (reduced sensation or proprioception).
• Joints that feel stiff or tight, sometimes getting worse as a child grows (stiffness or contractures).

Children with hemiplegic cerebral palsy (CP affecting one side of the body) often have more noticeable involvement of one upper limb, while in children with quadriplegic cerebral palsy both arms are affected.

What are the signs and symptoms of cerebral palsy upper extremity disorders?

Upper extremity conditions in children with cerebral palsy may involve the shoulder, elbow, forearm, wrist or hand. These issues can affect both movement and function and cause discomfort or pain.

Common signs and symptoms of arm or hand disorders in a child with cerebral palsy include:

• Shoulders that feel tight or turn inward (internal rotation).
• Difficulty straightening the elbow (elbow flexion contractures).
• Difficulty rotating the forearm, especially turning the palm up.
• Wrists that bend forward or backward more than they should (flexion or extension deformities).
• A thumb that curls into the palm instead of staying out to the side (thumb-in-palm deformity).
• Finger stiffness or difficulty opening the hand.
• Using one arm or hand more than the other (asymmetric use).

For parents and caregivers, these symptoms may look like:

• Difficulty reaching or using one or both hands.
• Trouble grasping, holding or releasing objects.
• Challenges with self-care tasks such as dressing, feeding or hygiene.
• Limited range of motion in the arm, wrist or fingers.

If these concerns affect daily activities or worsen over time, an evaluation by a specialist may be helpful.

How do you test for and diagnose arm and hand disorders caused by cerebral palsy?

First, we evaluate the physical movement, and functional use of the arm and hand. Sometimes appearance can be important, too. 

At CHOP, assessment for an arm or hand disorder may include:

• A detailed physical and neurological examination.
• Evaluation of muscle tone, strength and joint range of motion.
• Assessment of active versus passive movement.
• Occupational therapy evaluation of hand function and daily activities.
• Observation of how the child uses their arm and hand during play or tasks.

What are the treatments for cerebral palsy arm and hand disorders?

 At CHOP, our care team works closely with families to understand each child’s goals and priorities, helping guide treatment decisions.

Occupational therapy plays a central role in arm and hand care for children with cerebral palsy, often focusing on:

• Improved strength, coordination and hand skills.
• Strategies for daily activities.
• Training with adaptive equipment or assistive devices.
• Home exercise programs to support ongoing progress.

Custom splints, braces and other orthoses may also be helpful and are often used to:

• Support proper joint positioning.
• Improve function during activities.
• Prevent or slow the development of contractures (stiffness or tightening).

Surgery is considered when arm or hand problems significantly limit function, cause pain or discomfort, or do not adequately respond to nonsurgical treatments. Surgery tends to focus on improving alignment, balance, and functional use of the arm and hand.

Specific surgical options may include:

• Release or lengthening of tight muscles or tendons.
• Tendon transfers to improve joint position or movement.
• Bone procedures to improve alignment in select cases.
• Nerve surgeries to reduce muscle tone and tightness in the arm.

Surgical planning is highly individualized and involves careful discussion among surgeons, therapists, patients and their families.

In select cases, botulinum toxin injections may be used to temporarily reduce muscle tone and improve movement or positioning. These injections are usually combined with therapy for the best results.

What follow-up care is needed for children with cerebral palsy who are treated for upper hand and arm disorders?

Rehabilitation is critical for children with arm and hand disorders caused by cerebral palsy. Whether the larger treatment plan is nonsurgical or surgical, children typically also participate in occupational therapy to:

• Maximize functional gains.
• Practice new movement patterns.
• Improve independence in daily activities.
• Support long-term outcomes.

Families and caregivers, of course, play an important role in helping children to continue their therapy at home and build upon their in-person rehab sessions. 

Can treatment improve the long-term outlook for children with cerebral palsy and upper extremity disorders?

Yes, increased function in your child’s arm or hand through treatment leads to greater comfort, helping your child – and you – to feel more confident.

When should you seek a cerebral palsy arm and hand disorder specialist like those at CHOP?

A referral to a cerebral palsy or arm and hand specialist may be helpful if:

• Upper extremity limitations interfere with daily activities.
• Function worsens as a child grows.
• Pain or discomfort develops.
• Advanced therapies or surgical options are being considered.

At CHOP, our Cerebral Palsy Program brings together pediatric orthopedic surgeons, rehabilitation specialists, occupational therapists and other experts to provide coordinated, comprehensive care for children with cerebral palsy. Our team focuses on individualized, family-centered treatment plans that support each and every child’s goals and quality of life.