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Surgery for Cerebral Palsy of the Arm + Hand - giving the hand a job it can do.

Tendon transfers, muscle releases and botulinum toxin adjuncts - chosen after a full MDT with hand therapy, orthotics and gait analysis. Function first, cosmesis second.

See indicative pricing
A radiographer guides a patient onto the bed of an advanced 3 Tesla MRI scanner in a London imaging suite

Indicative pricing

What surgery for cerebral palsy of the arm + hand costs privately in the UK.

Indicative ranges across our partner units.

In short

Wrist tendon transfer: £6,500–£12,500, home the next day.

Service Indicative range
Botulinum toxin injection (per session) £650–£1,400
Wrist tendon transfer (FCU to ECRB) £6,500–£12,500
Pronator release (with or without transfer) £5,500–£9,500
Thumb-in-palm correction £6,500–£12,000
Elbow flexion contracture release £7,500–£13,500
MDT consultation and video assessment £450–£850
Hand therapy bundle (8 sessions) £720–£1,440

CP upper-limb surgery is usually covered by private medical insurance where functionally indicated.

The problem

The right transfer, at the right joint, at the right age.

Upper-limb CP surgery lives or dies by patient selection, MDT judgement and post-op therapy. All three matter more than the technical detail.

  • MDT decides the operation

    Hand therapist, orthotist, physiatrist and surgeon together - never a solo surgical call.

  • Botulinum toxin is a preview

    A 3-month reversible trial informs a lifetime decision. We use it liberally before we commit.

  • Therapy after is the operation

    Six months of splinting and 12 weeks of therapy decide the result more than any transfer.

When it helps

The situations where this is the right step.

The situations we see most, plus the red flag that means urgent care rather than a routine appointment.

  • Wrist and finger flexion contracture

    The classic CP hand - wrist in flexion, ulnar deviation, fingers curled. FCU transfer + finger release helps in the right candidate.

  • Thumb-in-palm

    A thumb held permanently across the palm blocks pinch and grip. Multi-step correction: release, transfer, MCP stabilisation.

  • Elbow flexion contracture

    Fixed flexion beyond 30° impairs hygiene and reach. Botulinum toxin trial first; surgical release where indicated.

  • Forearm pronation contracture

    A forearm stuck in pronation cannot present the palm for feeding or writing. Pronator release with or without transfer.

  • Shoulder adduction and internal rotation

    Difficulty reaching the face and putting on clothes. Subscapularis and pec major lengthening or transfer for selected patients.

  • Dystonic hyperkinesia

    Where movements are involuntary and unpredictable, surgery is offered cautiously - intrathecal baclofen or DBS may fit better.

  • Hygiene and dressing goals

    Real, functional goals - not cosmesis. Hand behind the head, palm to the mouth, thumb to fingertip - a family goal in writing is worth 10 videos.

  • Red flag: rapidly progressive weakness

    A recent worsening in an established CP hand needs neurology review before any operation is planned.

Options

Approach and extent depend on the case.

What each option involves - and where each earns its place.

  • Botulinum toxin (chemodenervation)

    A reversible “trial” of tone reduction - 3 months of effect, tells you what a release will feel like, and buys therapy a window.

  • Tendon transfers

    FCU-to-ECRB is the classic - improves wrist extension. Others: FCR-to-ECRB, brachioradialis-to-ECRB, ECU-to-ECRB.

  • Tendon releases and Z-lengthenings

    For spastic contractures - a controlled length gain in a specific muscle without ending its function completely.

  • Joint stabilisations and fusions

    For unstable joints - MCP fusion for a floppy thumb, or wrist fusion where nothing else has worked.

  • Combined multi-level surgery

    Several procedures under one anaesthetic - cast once, therapy once, family life disrupted once.

  • Intrathecal baclofen pump

    For dystonic or severe generalised spasticity - neurosurgical implant rather than upper-limb operation.

  • Selective dorsal rhizotomy (rare in upper limb)

    Mostly a lower-limb procedure; occasionally considered as part of a global tone management strategy.

  • Splinting and therapy alone

    Sometimes the right answer. The MDT will say so if it is.

Our vetted UK network

A small, hand-picked panel of clinicians.

Consultants across London and the major UK cities. Introductions are private once we understand your case.

  • Consultant paediatric and adult hand surgeons

  • Hand therapy on site with CP experience

  • Orthotist and neurorehab consultant in every MDT

  • Video-based outcome measures (SHUEE, AHA) at 6 and 12 months

Safety and recovery

What to expect - honestly.

The things worth planning for, and the red flags that mean same-day care.

  • GA safety in CP

    Anaesthetic risk is a little higher in patients with epilepsy, respiratory issues or scoliosis - a paediatric-anaesthetist assessment is standard.

  • Under-correction and over-correction

    Both possible. The former needs revision; the latter is harder to undo. Careful tension setting and intraoperative testing matter.

  • Tendon rupture or adhesion

    Rare with good technique; adhesions are minimised by early controlled therapy.

  • Nerve injury

    Rare - surgeons who work in this field routinely know the anatomy well.

  • Cast complications

    Skin breakdown, cast loosening, wet cast - the family knows what to check and how to contact the team same-day.

  • Loss of grip strength

    A theoretical trade-off with some transfers; carefully avoided by respecting the donor muscle’s remaining function.

  • Not a cure for cerebral palsy

    Surgery changes the mechanics of a limb, not the cortex. Realistic goals in writing before consent.

  • Long haul, worth it

    6 weeks of cast, 12 weeks of therapy, 6 months of night splinting - the outcome depends on the work after theatre.

  • Red flags after surgery

    Wet or slipping cast, fingertip colour change, uncontrolled pain, or fever is same-day team, not a routine call.

Reading your notes

Your report in four parts. Read the last one first.

Whatever the pathway, the summary keeps to the same shape.

  1. 01 Assessment

    Baseline function and goals

    MACS score, SHUEE / AHA baseline, video, and functional goals agreed with family.

  2. 02 Procedure

    Which transfers, which releases

    Named tendons, lengths gained, tension set, and any adjunct such as botulinum toxin at the same sitting.

  3. 03 Aftercare

    Cast, therapy, splint

    Cast duration, therapy start, splint schedule for 6 months, and equipment list for the family.

  4. 04 Outcomes

    Reassessment at 6 and 12 months

    Read this first: goals reviewed, functional scores repeated, and any further plan for the same limb or the other.

Recognised by major UK insurers

BupaAXA HealthVitalityAvivaWPACignaHealixBupaAXA HealthVitalityAvivaWPACignaHealixBupaAXA HealthVitalityAvivaWPACignaHealix

Frequently asked

Everything we get asked about surgery for cerebral palsy of the arm + hand.

  • What is the right age for CP hand surgery?

    Static (non-progressive) deformities are usually addressed after age 6, when the child can engage with therapy and cooperate with splinting. Selected earlier operations are done for severe deformities. Adults benefit too - CP does not have an upper age limit for functional surgery.

  • Will surgery cure the cerebral palsy?

    No. Surgery changes the mechanics of a limb - the cortex is unchanged. The goal is functional improvement for real activities: hygiene, dressing, feeding, keyboard, sport. Realistic goals in writing before consent is standard.

  • What is a tendon transfer?

    A muscle whose spastic pull is causing a problem is disconnected from its original insertion and moved to a new one where it does useful work. The classic is the flexor carpi ulnaris transferred to the extensor carpi radialis brevis - turning a wrist-flexor problem into a wrist-extensor solution.

  • Does botulinum toxin count as surgery?

    No, but it is a critical adjunct. A botulinum toxin trial before a permanent release predicts what the operation will feel like. It also buys a 3-month window for therapy to strengthen the antagonists.

  • How long is recovery, honestly?

    Cast 4–6 weeks, active therapy 6–12 weeks, splint at night for 6 months. Functional gains keep improving to 12 months. This is a long haul with a big pay-off in the right patient.

  • How much does private upper-limb CP surgery cost in the UK?

    Botulinum toxin runs £650–£1,400 per session. Wrist tendon transfer £6,500–£12,500. Thumb-in-palm correction £6,500–£12,000. Elbow release £7,500–£13,500.

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