13.1

Wrist drop

• 1.
  

  Clinical feature: wrist flexion with/without ulnar or radial deviation.

  
  
• 2.
  

  Botulinum toxin injection:

  
  
  
  
  • a.
    

    Primary target muscles: wrist flexors: palmaris longus (4-4), flexor carpi radialis and/or ulnaris (4-5 & 4-6) depending on deviation (radial or ulnar).

    
    
  • b.
    

    Secondary target muscles: finger flexors: flexor digitorum superficialis & profundus (4-7 & 8), only if finger flexors hypertonia is combined.

  
  

13.2

Cortical thumb

• 1.
  

  Clinical feature: clenched fist but thumb is covered by other four fingers.

  
  
• 2.
  

  Botulinum toxin injection:

  
  
  
  
  • a.
    

    Primary target muscles: thumb opponens (5-2), adductor (5-4), and flexors (4-9 & 5-3, see note) finger flexors: flexor digitourm superficialis & profundus (4-7 & 8).

  
  

Note: If thumb interphalangeal joint is not flexed, flexor pollicis longus is not targeted.

13.3

Hand intrinsic minus (claw hand)

From Kozin SH, Lightdale-Miric N. Chapter 32 – Spasticity: Cerebral Palsy and Traumatic Brain Injury. In: Wolfe SW, Pederson WC, Kozin SH, Cohen MS, eds. Green’s Operative Hand Surgery. 7 ^th ed. Elsevier; 2017

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