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Extensor Carpi Ulnaris to Extensor Carpi Radialis Brevis Tendon Transfer in Pediatric Patients with Cerebral Palsy

Christopher S Crowe1,2, Natalie Williams3, Zachary Weingrad3

  • 1From the Division of Plastic Surgery, Department of Surgery, University of Washington.

Plastic and Reconstructive Surgery
|December 9, 2025
PubMed

Insights

The extensor carpi ulnaris (ECU) to extensor carpi radialis brevis (ECRB) tendon transfer effectively corrects spastic wrist flexion in cerebral palsy (CP) patients. This procedure improves wrist posture and grasp, offering a safe alternative for managing CP-related hand deformities.

Area of Science:

  • Orthopedic surgery
  • Pediatric neurology
  • Rehabilitation medicine

Background:

  • Spastic wrist flexion deformity is a common challenge in cerebral palsy (CP), impacting hand function and visibility of neurological impairment.
  • Traditional flexor carpi ulnaris (FCU) to extensor carpi radialis brevis (ECRB) tendon transfer can correct flexion but risks overcorrection (hyperextension).

Purpose of the Study:

  • To evaluate the surgical technique and outcomes of an alternative tendon transfer: extensor carpi ulnaris (ECU) to ECRB.
  • To assess the efficacy of ECU to ECRB transfer in improving wrist extension and grip strength in pediatric CP patients.

Main Methods:

  • A retrospective analysis of pediatric CP patients undergoing ECU to ECRB tendon transfer.
  • Assessment of wrist position, range of motion, active grasp, and patient-reported grasp improvement.
  • Evaluation of secondary outcomes, including the need for revision surgery.

Main Results:

  • Twenty-six wrists in 24 patients were treated with ECU to ECRB transfer.
  • 85% of wrists achieved extension beyond neutral post-surgery (average 28 degrees).
  • 81% of patients reported improved grasp; 5 required revision for recurrent flexion, 1 for fixed extension.

Conclusions:

  • ECU to ECRB tendon transfer is a safe and effective surgical option for managing spastic wrist flexion in cerebral palsy.
  • The procedure reliably enhances wrist posture and grip function in affected individuals.
  • This technique offers a viable alternative to traditional tendon transfers, with a low rate of significant complications.
Abstract

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