- adduction contractures of shoulder and flexion contractures of elbow are not a problem in themselves, as muscle weakness renders
patient unable to abduct the arm above the level of the shoulder or to extend the elbow against gravity;
- pronation contractures of the forearm and flexion contractures of wrist and the MCP and PIP joints also occur;
- tightness is demonstrated when passive dorsiflexion of the wrist is associated with obligate flexion of the fingers, due to the tightness of the
long flexors of the fingers;
- treatment of all joints of the upper extremities involves daily, passive, range-of-motion exercises to minimize contractures.
- when passive dorsiflexion of the wrist is limited to neutral, patient should wear orthoses at night