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Flexor Carpi Ulnaris Myotendinous Lengthening Improves Function in Children with Spastic Hemiplegic Cerebral Palsy
PAPER 83 Clinical Paper Session 15: Pediatrics Saturday, September 12 4:03e4:10 PM Treatment, Hand and Wrist, Congenital and Pediatric Problems
Flexor Carpi Ulnaris Myotendinous Lengthening Improves Function in Children with Spastic Hemiplegic Cerebral Palsy Level 4 Evidence
Matthew B. Burn, MD Gloria R. Gogola, MD Hypothesis: Children with spastic hemiplegic cerebral palsy with dynamic wrist flexion position during tasks, but with volitional wrist extension in isolation are often treated with Botox, which may limit muscle strength and growth. As the dynamic limitations in wrist movement are due to both abnormal myofascial loads as well as to abnormal patterns of muscle activation, we hypothesize that reducing the non-neural component via myotendinous lengthening of the flexor carpi ulnaris can reduce wrist impairment while maintaining muscle strength. Methods: We performed a respective cohort study of forty children with spastic hemiplegic cerebral palsy (mean age 10.7 years, range 4.3-to-
17 years old; 24 boys, 16 girls; MACS 1-4), with dynamic wrist flexion contractures who had FCU fractional lengthening as part of their single event multi-level surgery. We analyzed each child’s SHUEE (Shriners Hospital for Children Upper Extremity Evaluation) for overall scores and wrist sub-scores, wrist active range of motion, Pediatric Outcomes Data Collection Instrument (PODCI) scores, wrist flexion and extension strength, grip and pinch strength, and gross motor dexterity (box & blocks test). These measurements were obtained pre-operatively and at 1 year post-operatively. Statistical analysis was completed using data analysis tool sets, such as two-tailed ttests, in Microsoft Excel. Results: At 1 year, there were significant improvements (P 0.05) was observed in the PODCI comfort/pain subsection, SHUEE grasp and release score, wrist flexion strength, or pinch strength. Summary: In children with spastic hemiplegic cerebral palsy with volitional wrist extension and dynamic wrist flexion contractures that impair function, FCU fractional lengthening can: Improve spontaneous use Improve dynamic wrist posture Improve grip strength Improve dexterity Preserve wrist flexion strength
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Flexor Carpi Ulnaris Myotendinous Lengthening Improves Function in Children with Spastic Hemiplegic Cerebral Palsy Level 4 Evidence
Matthew B. Burn, MD Gloria R. Gogola, MD Hypothesis: Children with spastic hemiplegic cerebral palsy with dynamic wrist flexion position during tasks, but with volitional wrist extension in isolation are often treated with Botox, which may limit muscle strength and growth. As the dynamic limitations in wrist movement are due to both abnormal myofascial loads as well as to abnormal patterns of muscle activation, we hypothesize that reducing the non-neural component via myotendinous lengthening of the flexor carpi ulnaris can reduce wrist impairment while maintaining muscle strength. Methods: We performed a respective cohort study of forty children with spastic hemiplegic cerebral palsy (mean age 10.7 years, range 4.3-to-
17 years old; 24 boys, 16 girls; MACS 1-4), with dynamic wrist flexion contractures who had FCU fractional lengthening as part of their single event multi-level surgery. We analyzed each child’s SHUEE (Shriners Hospital for Children Upper Extremity Evaluation) for overall scores and wrist sub-scores, wrist active range of motion, Pediatric Outcomes Data Collection Instrument (PODCI) scores, wrist flexion and extension strength, grip and pinch strength, and gross motor dexterity (box & blocks test). These measurements were obtained pre-operatively and at 1 year post-operatively. Statistical analysis was completed using data analysis tool sets, such as two-tailed ttests, in Microsoft Excel. Results: At 1 year, there were significant improvements (P 0.05) was observed in the PODCI comfort/pain subsection, SHUEE grasp and release score, wrist flexion strength, or pinch strength. Summary: In children with spastic hemiplegic cerebral palsy with volitional wrist extension and dynamic wrist flexion contractures that impair function, FCU fractional lengthening can: Improve spontaneous use Improve dynamic wrist posture Improve grip strength Improve dexterity Preserve wrist flexion strength
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