Functional Outcome of Upper Limb Tendon Transfers Performed in Children with Spastic Hemiplegia

Abstract

Children with spastic hemiplegia often present with upper limb muscle imbalance. The purpose of this paper was to determine whether reconstructive surgery improved their functional ability. 17 children under the age of 16 years with spastic hemiplegia underwent reconstruction that included tendon transfers, tendon lengthenings and thumb metacarpophalangeal fusion. They were assessed pre-operatively and at an average follow-up period of 2.6 years. Children's abilities were classified according to House's functional rating scale. Tendon transfers improved functional grading by two grades, from good passive assist to fair active assist. Improvement in the arc of wrist motion and forearm rotation was also seen. Parental satisfaction was high. Reconstructive surgery improved the functional abilities in this group of children with spastic hemiplegia.

Does surgical management of the hand in children with spastic unilateral cerebral palsy affect functional outcome?

“…These results are in line with the reports of Matsuo et al, 9 Tonkin and Gschwind, 10 and Gschwind, 11 which describe functional improvement in the majority of individuals after surgery of the spastic hand, however without providing a statistical foundation. The quality of stereognosis 3,6,16 and level of cognition 6 did not affect outcome. One study reported that patients with poor sensibility, motor control, and hand placement failed to improve function.…”

“…First, a more proper position of the hand and fingers may facilitate hand function. 3,16 Second, reallocation of function of, for instance, a relatively strong wrist flexor to extensor function may improve impaired extensor actions. 4 Third, it is conceivable that a better peripheral starting point may alter cortical maps, which, in turn, might be associated with a larger repertoire of hand strategies.…”

Surgical Treatment of Pronation Contracture of the Forearm in Patients With Infantile Cerebral Palsy

“…В настоящее время показания к хирурги-ческому лечению вариабельны у различных авторов. Это может быть невозможность активной супинации более чем на 20-30° [7,11], невозможность активно супинировать предплечье до среднего положения [9,10] или же наличие контрактуры, ограничивающей функцию конечности [4,5].…”

Тreatment Strategy of Flexion Contracture of the Wrist Joint in Children With Cerebral Palsy

“…Как правило, сгибательная контрактура лу-чезапястного сустава носит прогрессирующий характер течения: укорачивается m. flexor carpi radialis, мышцы сгибатели пальцев кисти, наруша-ются суставные соотношения в кистевом суставе, может сформироваться подвывих [8,10].…”