Hand function after muscle transfer in spastic hemiparesis patients

In spastic hemiparesis, upper extremity issues pose challenges for orthopaedic surgeons, neurologists, physiotherapists, and occupational therapists. Various interventions aim to decrease contractures, improve hand function, and enhance mobility. The aim of the study was evaluation of hand function after tendon transfer in spastic hemiparesis in cerebral palsy.

A retrospective review was performed of in- and outpatient charts (from 2006) across two centres: a referral facility for cerebral palsy and a paediatric orthopaedic clinic. Inclusion criteria was spastic hemiplegia of the upper limb, treated surgically with muscle transfer. Exclusion criteria were dystonia or other coordination disorders, bilateral involvement, or prior upper limb surgeries. Minimum follow-up - 2 years.

Thirty patients (14 females, 16 males) met the criteria; mean surgery age - 11.5 years (range 10-15). All were GMFCS II or III and MACS 2 or 3, with extrinsic-type hands per Zancolli (14 group 1, 10 group 2a, 6 group 2b). All initially underwent ray plasty, FCU-to-ECRL transfer, and pronator teres release. Two had biceps lengthening; one had finger flexor myotomy. All reported self-perceived functional gains (e.g., improved grasp, pencil holding, self-feeding), verified by therapists. Hand and forearm alignment improved without MACS classification change; function according to Zancolli classification improved.

Muscle transfer surgery improved upper extremity position and function in spastic hemiplegic patients. The group for surgery has to be carefully selected. There is a need of standardization of reporting goals and outcomes in this selected population, as well as choosing the procedure required by an experienced team.