Cerebral Palsy-Upper Extremity Surgical Treatment of Cerebral Palsy

Upper Extremity Surgical Treatment of Cerebral Palsy

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This report reviews the surgical treatment of upper extremity involvement in cerebral palsy over a 25-year period and presents the results in terms of changes in upper limb function. The study reviews 180 operations representing 718 procedures in 134 patients. Surgical treatment involved soft tissue releases of deforming spastic muscles, tendon transfers to augment opposing muscle activity, and joint stabilization. The average improvement in functional use scores, as measured by a 9-level scale, was 2.6 functional levels for all patients. Patients with fair and good voluntary control had significantly greater improvement in functional use scores than those with poor voluntary control. Other cofactors, such as type of cerebral palsy, age, mental impairment, and sensibility, did not have a significant predictive effect on surgical outcome. The study concludes that surgical intervention improves function in selected patients with upper extremity dysfunction due to spastic cerebral palsy. The surgical procedures most commonly performed were pronator teres and biceps aponeurosis release for forearm pronation deformity, and tendon transfers to extensor carpi radialis and/or brevis using flexor carpi ulnaris, brachioradialis, or extensor carpi ulnaris for wrist flexion/ulnar deviation deformity. The study also compared the results of different wrist tendon transfers and found no significant differences in functional improvement between transfers. The results of this study provide valuable information for hand surgeons and underscore the importance of surgical intervention in improving upper extremity function in patients with cerebral palsy.

Keywords

surgical treatment

upper extremity involvement

cerebral palsy

upper limb function

functional use scores

voluntary control

surgical outcome

pronator teres

biceps aponeurosis release

wrist tendon transfers