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.