Quantitative and Qualitative Functional Evaluation of Upper Extremity Tendon Transfers in Spastic Hemiplegia Caused by Cerebral Palsy

• Published in: Journal of pediatric orthopaedics Vol. 28; no. 6; pp. 679 - 683
• Main Authors: Van Heest, Ann E, Ramachandran, Vimala, Stout, Jean, Wervey, Roy, Garcia, Louis
• Format: Journal Article
• Language: English
• Published: Hagerstown, MD Lippincott Williams & Wilkins, Inc 01-09-2008; Lippincott
• Subjects: Adolescent; Adult; Biological and medical sciences; Cerebral Palsy - physiopathology; Cerebral Palsy - surgery; Child; Diseases of the osteoarticular system; Female; Follow-Up Studies; Hand - physiopathology; Hand - surgery; Headache. Facial pains. Syncopes. Epilepsia. Intracranial hypertension. Brain oedema. Cerebral palsy; Hemiplegia - etiology; Hemiplegia - surgery; Humans; Male; Medical sciences; Nervous system (semeiology, syndromes); Nervous system as a whole; Neurology; Range of Motion, Articular; Tendon Transfer - methods; Time and Motion Studies; Treatment Outcome; Upper Extremity - physiopathology; Upper Extremity - surgery; Wrist Joint - physiopathology; Wrist Joint - surgery; Cerebral palsy; Motion; Nervous system diseases; Motor system disorder; motion laboratory; spastic hemiplegia; Upper extremity; Cerebral disorder; Orthopedics; Central nervous system disease; Hemiplegia; Upper limb; Neurological disorder; Quantitative analysis; Tendon
• ISSN: 0271-6798; 1539-2570
• DOI: 10.1097/BPO.0b013e3181831eac

BACKGROUND:The purpose of this study was to determine if upper extremity function and joint positioning improved after tendon transfer surgery in patients with spastic hemiplegia caused by cerebral palsy.
METHODS:Thirteen patients with spastic hemiplegia underwent tendon transfer surgery at a mean age of 10.8 years (range, 7-24 years). Before surgery, all patients were evaluated with a standardized motion laboratory analysis protocol. At a mean follow-up of 3.6 years (range, 1-10 years), 13 patients returned for a repeat motion laboratory analysis using the same protocol. The motion laboratory studies were then compared quantitatively, comparing times for completion of the Jebsen-Taylor hand test, and qualitatively for elbow, forearm, wrist, finger, and thumb positions using the validated Shriner's Hospital Upper Extremity Evaluation protocol.
RESULTS:In timed testing on the Jebsen-Taylor hand function test, 5 patients improved, 5 patients remained the same, and 3 patients worsened. No statistically significant change in timed testing was noted for any of the 6 subtests. A qualitative assessment of limb position during completion of tasks showed a significant improvement in position for the elbow (P < 0.01), forearm (P < 0.02), wrist (P < 0.02), and fingers (P < 0.02). There was no significant change in thumb position (P < 0.85).
CONCLUSIONS:Tendon transfers, especially for wrist extension, can be beneficial in improving upper extremity joint positioning in children with spastic hemiplegia. However, significant impairment in hand function persists.