Functional Result of Tendon Transfers and Releases for the Upper Extremity in Spastic Hemiplegic Cerebral Palsy

• Published in: Hand (New York, N.Y.) N.Y.), 2016-09, Vol.11 (1_suppl), p.103S-104S
• Main Authors: Carrasco, Marcia, Méndez, Manuel, Aguilera, Marcela, Naranjo, Gianette, Parot, Catalina
• Format: Article
• Language: English
• ISSN: 1558-9447; 1558-9455
• DOI: 10.1177/1558944716660555gt

Purpose: To evaluate the functional and postural outcomes with Shriners Hospital for Children Upper Extremity Evaluation (SHUEE) Test, stereognosis of tendon transfers, and releases for the upper extremity, in adolescents with spastic hemiplegic cerebral palsy (CP). Material and Methods: Prospective study of 11 patients with spastic hemiplegic CP, 8 men, 4 female, between 10 and 16 years of age (mean, 13 years). Inclusion criteria were no fixed articular deformity and patients capable to follow instructions. Surgery consists in a one-time procedure of tendon transfers and releases according to SHUEE and clinical preoperative evaluation. Surgical procedures were done considering individual evaluations as follows: adductor pollicis (AP) release and extensor pollicis longus (EPL) rerouting, 11 patients; extensor carpi ulnaris (ECU) to extensor carpi radialis longus transfer (ECRL), 6 patients; flexor carpi ulnaris (FCU) to extensor carpi radialis brevis (ECRB) transfer, 3 patients; pronator teres (PT) rerouting, 4 patients; release of the FCU, 3 patients; release of the PT, 4 patients; superficial finger flexor tendons release, 3 patients; and swan deformity correction, 3 patients. Before tendon transfer, muscles were previously assed by dynamic electromyography to confirm phasic behavior. Postoperative protocol includes 1-month cast immobilization followed by 20 sessions of physical therapy, orthotic, and scar compression. Assessment with SHUEE, 12-element stereognosis test, and HOUSE classification (JH House) were done at preoperative, 6 and 12 months after surgery. Results: Friedman analysis of the 3 sections of the SHUEE was done. The spontaneous functional analysis of SHUEE (SFA) improves from 53% preoperative to 62% at 12 month of surgery, which was not significant (P, .12). Dynamic positional analysis (DPA) improves significantly from 53% preoperative to 64% at 6 months and 76% at 12 months of surgery (P, .004), the best result was in wrist and the worse was thumb. There were significant improvements of the grasp and release analysis (GRA) from 82% to 100% at 12 months (P, .002). No significant changes in stereognosis were observed improving from 50% to 75% (P, .05). Functional classification of HOUSE before surgery was 3 to 7. All patients improved their function in HOUSE scale 1 or 2 levels at 6 months and 1 to 3 levels at 12 month. Conclusions: Tendon transfers and releases for the upper extremity in spastic hemiplegic CP adolescents without fixed a