Quantitative and qualitative functional evaluation of upper extremity tendon transfers in spastic hemiplegia caused by cerebral palsy.

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.