Cerebral palsy (CP) of the spastic type is a neurological disorder characterized by a velocity-dependent increase in tonic stretch reflexes with exaggerated tendon jerks. Secondary to the spasticity, muscle adaptation is presumed to contribute to limitations in the passive range of joint motion. However, the mechanisms underlying these limitations are unknown. Using biopsies, we compared mechanical as well as histological properties of flexor carpi ulnaris muscle (FCU) from CP patients (n = 29) and healthy controls (n = 10). The sarcomere slack length (mean 2.5 µm, SEM 0.05) and slope of the normalized sarcomere length-tension characteristics of spastic fascicle segments and single myofibre segments were not different from those of control muscle. Fibre type distribution also showed no significant differences. Fibre size was significantly smaller (1933 µm2, SEM 190) in spastic muscle than in controls (2572 µm2, SEM 322). However, our statistical analyses indicate that the latter difference is likely to be explained by age, rather than by the affliction. Quantities of endomysial and perimysial networks within biopsies of control and spastic muscle were unchanged with one exception: a significant thickening of the tertiary perimysium (3-fold), i.e. the connective tissue reinforcement of neurovascular tissues penetrating the muscle. Note that this thickening in tertiary perimysium was shown in the majority of CP patients, however a small number of patients (n = 4 out of 23) did not have this feature. These results are taken as indications that enhanced myofascial loads on FCU is one among several factors contributing in a major way to the aetiology of limitation of movement at the wrist in CP and the characteristic wrist position of such patients.

This high recurrence rate suggests that radiotherapy might be less efficacious than suggested by other studies. On the basis of the authors' results, surgical excision combined with radiotherapy should be reserved as a last resort in the treatment of therapy-resistant keloids.

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The effect of combined pronator teres rerouting and flexor carpi ulnaris transfer on forearm rotation was prospectively studied by comparison of pre- and postoperative three-dimensional analysis of forearm range of motion in ten patients with cerebral palsy. One year postoperatively, surgery had improved maximal supination of the forearm in all patients by an average of 63 degrees, but there was also a mean loss of 40 degrees pronation. Forearm range of motion increased by a mean of 23 degrees. The centre of the range of motion on average shifted 52 degrees in the direction of supination. Based on these results of objective forearm range of motion analysis, we conclude that the common combination of pronator teres rerouting and flexor carpi ulnaris transfer in patients with cerebral palsy effectively facilitates active supination but impairs active pronation.

Our aim was to determine whether the length and function of the flexor carpi ulnaris muscle were affected by separating it from its soft tissue connections. We measured the length of flexor carpi ulnaris before and after its dissection in ten patients with cerebral palsy. After tenotomy, tetanic contraction shortened the muscle by a mean of 8 mm. Subsequent dissection to separate it from all soft tissue connections, resulted in a further mean shortening of 17 mm (p < 0.001). This indicated that the dissected connective tissue had been strong enough to maintain the length of the contracting muscle. Passive extension of the wrist still lengthened the muscle after tenotomy, whereas this excursion significantly decreased after subsequent dissection. We conclude that the connective tissue envelope, which may be dissected during tendon transfer of flexor carpi ulnaris may act as a myofascial pathway for the transmission of force. This may have clinical implications for the outcome after tendon transfer.

Extramuscular connective tissue and muscular fascia have been suggested to form a myo‐fascial pathway for transmission of forces over a joint that is additional to the generally accepted myo‐tendinous pathway. The consequences of myo‐fascial force transmission for the outcome of conventional muscle tendon transfer surgery has not been studied as yet. To test the hypothesis that surgical dissection of a muscle will affect its length‐force characteristics, a study was undertaken in adult male Wistar rats. During progressive dissection of the flexor carpi ulnaris muscle, isometric length‐force characteristics were measured using maximal electrical stimulation of the ulnar nerve. After fasciotomy, muscle active force decreased by approximately 20%. Further dissection resulted in additional decline of muscle active force by another 40% at maximal dissection. The muscle length at which the muscle produced maximum active force increased by approximately 0.7 mm (i.e. 14% of the measured length range) after dissection. It is concluded that, in rats, the fascia surrounding the flexor carpi ulnaris muscle is a major determinant of muscle length‐force characteristics. © 2002 Orthopaedic Research Society. Published by Elsevier Science Ltd. All rights reserved.

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