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Tendon transfer surgery in upper-extremity cerebral palsy is more effective than botulinum toxin injections or
Ann E Van Heest1, Anita Bagley2, Fred Molitor2
1Department of Orthopaedic Surgery, University of Minnesota, 2450 Riverside Avenue, Suite R200, Minneapolis, MN 55454.
Insights
Surgical treatment for pediatric upper-extremity cerebral palsy (CP) demonstrated superior functional gains compared to botulinum toxin or ongoing therapy. This study highlights surgery as a more effective option for improving arm function in children with CP.
Area of Science:
- Orthopedic Surgery
- Pediatric Rehabilitation
- Cerebral Palsy Research
Background:
- Children with upper-extremity cerebral palsy (CP) often require interventions to improve function.
- Standard surgical candidates typically undergo tendon transfer procedures.
Purpose of the Study:
- To compare the efficacy of surgical treatment versus botulinum toxin injections or regular therapy for children with upper-extremity CP.
- To evaluate functional improvements in children with CP undergoing different treatment modalities.
Main Methods:
- A prospective study involving 39 children (4-16 years) with upper-extremity CP.
- Participants were assigned to surgical treatment, botulinum toxin injections, or regular therapy.
- Outcomes included range of motion, strength, stereognosis, and functional scores, assessed at 12 months.
Main Results:
- Surgical treatment (Group 1) showed significantly greater improvement in the SHUEE DPA compared to botulinum toxin (Group 2) or therapy (Group 3).
- Group 1 also demonstrated superior improvements in the PedsQL CP module (movement) and COPM satisfaction scores.
- Both surgical and therapy groups showed greater pinch strength improvement than the botulinum toxin group.
Conclusions:
- Surgical tendon transfer offers greater functional improvement for children with upper-extremity CP compared to botulinum toxin or ongoing therapy.
- The benefits of surgery were observed at 12 months post-treatment, impacting dynamic positional analysis, quality of life, and satisfaction.
- These findings support surgical intervention for eligible pediatric CP patients seeking enhanced arm function.
Background:
For children with upper-extremity cerebral palsy (CP) who meet standard indications for tendon transfer surgery, we hypothesized that surgical treatment would result in greater functional improvement than treatment with botulinum toxin injections or regular, ongoing therapy.
Methods:
Thirty-nine children with upper-extremity CP, who were four to sixteen years of age and surgical candidates for the transfer of the flexor carpi ulnaris to the extensor carpi radialis brevis, pronator teres release, and extensor pollicis longus rerouting with adductor pollicis release, were prospectively assigned, either randomly (twenty-nine patients) or by patient/family preference (ten patients), to one of three treatment groups: surgical treatment (Group 1); botulinum toxin injections (Group 2); or regular, ongoing therapy (Group 3). Seven centers participated. Assessment measurements included active range of motion, pinch and grip strength, stereognosis, and scores as measured with eight additional functional or patient-oriented outcome instruments. Thirty-four patients (twenty-five randomized and nine from the patient-preference arm) were evaluated twelve months post-treatment as the study cohort.
Results:
For the primary outcome of the Shriners Hospital Upper Extremity Evaluation (SHUEE) dynamic positional analysis (DPA), significantly greater improvement was seen in Group 1 than in the other two groups (p < 0.001). Improvements in SHUEE DPA reflected improved supination and wrist extension during functional activities after surgical treatment. Group 1 showed more improvement in the Pediatric Quality of Life Inventory (PedsQL) CP module domain of movement and in the Canadian Occupational Performance Measure (COPM) score for satisfaction than Groups 2 and 3. Both Groups 1 and 3 showed more improvement in pinch strength than did Group 2.
Conclusions:
For children with upper-extremity CP who were candidates for standard tendon transfer, surgical treatment was demonstrated to provide greater improvement, of modest magnitude, than botulinum toxin injections or regular, ongoing therapy at twelve months of follow-up for the SHUEE DPA, the PedsQL CP module domain of movement, and COPM satisfaction.
