The Dynamic Thumb-in-Palm Pattern in Children with Spastic Cerebral Palsy and Its Effects on Upper Limb Function

The thumb-in-palm (TIP) pattern is one of the most common upper limb deformities in cerebral palsy (CP). This study was designed to investigate the effect of the dynamic TIP pattern on upper limb function in children with spastic CP. This prospective observational study included a total of 106 children with CP with dynamic TIP. The House TIP classification while grasping small or large objects, Melbourne Assessment of Unilateral Upper Limb Function (MUUL), Shriners Hospital Upper Extremity Evaluation (SHUEE), Zancolli classification for wrist-finger flexor deformity, and degree of swan neck deformity were assessed. Type I was the most common and highest functioning House TIP classification type. However, there were no significant differences in upper arm function between types II, III, and IV. The three components of the SHUEE showed stronger association with MUUL than House TIP and Zancolli classifications. After multivariable analysis, functional use of the wrist-finger and the thumb played a more significant role than the dynamic alignment of the thumb. In conclusion, the House TIP classification is useful to describe the TIP pattern. The SHUEE thumb assessment is a useful tool for reflecting upper arm function. The upper arm function was related more with the associated wrist flexor deformity than dynamic TIP.