Elsevier

The Journal of Hand Surgery

Volume 11, Issue 6, November 1986, Pages 836-840
The Journal of Hand Surgery

Long-term follow-up on tendon transfers to the extensors of the wrist and fingers in patients with cerebral palsy

https://doi.org/10.1016/S0363-5023(86)80232-5Get rights and content

Thirty-eight patients with cerebral palsy had tendon transfers to improve extension of the wrist and fingers. The 10 patients who had poor hand placement, sensibility, or motor control failed to improve in functional grasp or release. The remaining 28 patients, with better preoperative criteria, had improved function. On long-term follow-up, S of the 12 patients with tranfers to the wrist extensor had extension contractures with difficulty in release, and in seventeen patients transfers to the finger extensors resulted in improved finger extension and release, with no sacrifice in the ability to grasp.

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    Green and Banks' original description recommended that the transfer be placed such that the wrist is held in 45° of extension and full supination; in that series, the authors reported no patients developed an extension posture.4 Most other authors recommended that the transfer be tensioned between neutral and 20° of extension.3,6,9,17 We agree with these authors and feel that the FCU to ECRB tendon transfer should be tensioned in no more than 30° of extension because postoperative hyperextension deformities have been reported in patients whose transfers were tensioned in maximum extension.8,9

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    An individualized and detailed functional evaluation is also a critical component for developing the appropriate surgical plan. Dynamic electromyography (EMG) provides a qualitative and quantitative assessment of voluntary motor control and the type of motor activity of muscles being considered for transfer.14–16 A videotaped evaluation of the upper extremity in children with CP provides an objective assessment of a patient’s motor performance and functional capacity.

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