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1University of Minnesota, Department of Orthopedic Surgery, Hand Surgery Section, Gillette Children's Specialtycare, Shriner's Hospital-Twin Cities Unit, 2450 Riverside Avenue South, R200, Minneapolis, MN 55454, USA. vanhe003@umn.edu
Insights
Hand surgery in children with cerebral palsy improves function, even with sensory deficits. Surgical interventions can enhance both motor and potentially sensory outcomes, challenging previous beliefs.
Area of Science:
- Orthopedics
- Pediatric Surgery
- Neurorehabilitation
Background:
- Children with cerebral palsy often present with both motor and sensory impairments affecting hand function.
- Historically, sensory deficiencies were considered a contraindication for surgical intervention in the upper extremity.
- Recent evidence challenges this doctrine, suggesting surgery may be beneficial despite sensory deficits.
Purpose of the Study:
- To evaluate the efficacy of upper extremity surgery in children with cerebral palsy, particularly concerning hand function.
- To investigate the impact of preoperative sensory deficits on surgical outcomes in this population.
- To determine if surgical interventions can improve both motor and sensory functions in the affected upper limbs.
Main Methods:
- Review of surgical outcomes in 134 children with cerebral palsy undergoing upper extremity intervention.
- Analysis of preoperative two-point discrimination and stereognosis in surgically treated patients.
- Examination of data from studies by Eliasson et al. (32 children, tendon transfers/muscle releases) and Dahlin et al. (36 patients, 18-month follow-up).
Main Results:
- Preoperative sensory impairments (50% impaired two-point discrimination, 75% impaired stereognosis) did not adversely affect surgical results.
- Tendon transfers and muscle releases showed positive outcomes irrespective of preoperative sensibility.
- Improved motor function post-surgery was associated with enhanced stereognosis, likely due to increased functional use.
Conclusions:
- Upper extremity surgery is effective in improving hand function in children with cerebral palsy, progressing from passive to active assist capabilities.
- Preoperative sensory deficits do not contraindicate surgical intervention and do not negatively impact outcomes.
- Appropriately planned tendon release and transfer surgery can lead to improvements in both motor and potentially sensory functions, with wrist and finger balance being crucial.
Abstract:
The surgical results of upper extremity intervention have been shown to improve hand function from paperweight/passive assist function to active assist function. Although children with cerebral palsy commonly have a sensibility deficiency in conjunction with their motor deficiency, several recent studies have disproved the previous doctrine that hand surgery should not be performed on children with sensibility deficiencies. The author's report of 134 children treated surgically showed that preoperatively 50% had impaired two-point discrimination and 75% had impaired stereognosis: impaired sensibility had no adverse effect on surgical results. Eliasson et al reported on 32 children treated surgically with tendon transfers and muscle releases. Impaired sensibility before the surgery did not influence the outcome. In fact, Dahlin et al reported 36 patients treated operatively and followed for 18 months, finding an improvement in stereognosis function associated with the improvement in their motor function, presumably because of improved functional use. Children with cerebral palsy can improve their motor function and perhaps also their sensibility function with appropriately planned and executed tendon release and transfer surgery. Balance of the wrist and fingers is the key clement in improvement of upper limb function.
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