Surgery for Cerebral Palsy Part 3: Classification and Operative Procedures for Thumb Deformity

Tonkin, Michael A.; Hatrick, N. C.; Eckersley, J. R. T.; Couzens, Greg

doi:10.1054/jhsb.2001.0601

Cited by 50 publications

(21 citation statements)

References 11 publications

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“…House et al 16 House thumb classification Deformity To classify thumb deformity 4-20y Four-level system Tonkin et al 21 Modified house thumb classification…”

Section: Four-level Systemmentioning

confidence: 99%

Upper limb function and deformity in cerebral palsy: a review of classification systems

McConnell

Johnston

Kerr

2011

Develop Med Child Neuro

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MACS Manual Ability Classification SystemAIM To review classification systems for the upper limb in children with cerebral palsy (CP), and evaluate their validity, reliability, and clinical utility to make recommendations for clinical practice and future research.METHOD We comprehensively searched electronic databases to identify upper limb classification tools and associated evidence of psychometric testing. Two independent reviewers assessed the quality of the psychometric studies, and rated the clinical utility of each system using previously published tools.RESULTS Eighteen classification systems were eligible for inclusion, with two primary functions:classification of function or deformity. Published evidence of psychometric testing was available for fewer than half of the identified systems. Reliability studies were frequently limited by sample size, rater blinding, representativeness, and the number of observers. The Manual Ability Classification System (MACS) demonstrated content validity and interrater reliability. The original and modified House functional, House thumb, swan-neck, and Zancolli systems had evidence of reliability; the modified House functional system also demonstrated criterion-related validity.INTERPRETATION This review supports the use of the MACS and modified House functional system to classify upper limb function in children with CP. Similarly, the House thumb and Zancolli systems are recommended to classify thumb, and hand and wrist deformity respectively.

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“…House et al 16 House thumb classification Deformity To classify thumb deformity 4-20y Four-level system Tonkin et al 21 Modified house thumb classification…”

Section: Four-level Systemmentioning

confidence: 99%

Upper limb function and deformity in cerebral palsy: a review of classification systems

McConnell

Johnston

Kerr

2011

Develop Med Child Neuro

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“…The aim is to obtain firm lateral pinch to the middle phalanx of the index finger during fist formation and abduction during finger and thumb extension prior to grasp. 2,4,5,[10][11][12][13][14][15][16][17] Fractioned lengthening of flexor pollicis longus through a separate incision in the forearm is indicated when spasticity of the extrinsic thumb flexor causes metacarpophalangeal and interphalangeal joint flexion, impairing the possibility of a lateral pinch position. [3][4][5]10,11) A surgical technique is proposed for the release of thenar muscles, specifically the Adductor Pollicis, Flexor Pollicis Brevis and 1st Dorsal InterOsseous through a dorsal approach parallel to the first metacarpal.…”

Section: Discussionmentioning

confidence: 99%

Adductor Tenotomy Combined with Palmar Capsulodesis for Spastic Thumb-in-Palm Deformity in Cerebral Palsy: Description of a Surgical Technique and Clinical Results

Luis-Alejandro

Bárbara

2017

J Hand Surg Asian-Pac Vol

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Background: Spastic thumb deformity in cerebral palsy significantly impedes hand function. Flexion-adduction forces across the first ray is the result from imbalance between intrinsic and extrinsic muscles. Multiples surgeries have been devised for the treatment of this condition such as contracture release and by tendon transfers for balancing the muscles forces. We report the results of a less demanding surgical technique, intended to avoid hyperextension of the metacarpophalangeal joint previously described in other series. Methods: Five patients with cerebral palsy who underwent a surgical correction for their thumb-in-palm deformity between January 2013 and August 2014 were included. All patients were assessed postoperatively with a minimum follow up of six months. Three criteria were chosen to evaluate functional ability: capacity to perform pinch, volitional muscle control and usefulness of the hand in daily life activities. Results: Patients who had surgery for spastic thumb deformity were reviewed. The thumb was maintained out of the palm in all patients. Three patients were able to perform correct pinch, achieved volitional muscle control and a more functional hand. One patient had limitation to achieve one of the evaluated daily life activities and one patient lacked active thumb movement for pinch, motor control and achieved no daily life activities. No postoperative complications were recorded. Conclusions: We present a less challenging technique that should be taken into account for the treatment of thumb-in-palm deformity. Appearance and functional improvement can be achieved with this surgical procedure avoiding disadvantages of secondary deformities.

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“…The objectives of the surgical treatment of thumb-in-palm deformity are to generate a strong lateral pinch on the mid-phalanx of the second middle finger -at fist form-and to maintain sufficient radial abduction during grabbing (29). The major challenge of the treatment is the multifactorial quality of the deformity.…”

Section: Surgical Treatment Of Finger and Thumb Deformities "Swan Necmentioning

confidence: 99%

Upper Extremity Surgery in Spastic Cerebral Palsy

Özkan

Tunçer²

2012

JAREM

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Involvement of the upper extremity in cerebral palsy often results in a typical pattern of spasticity, with elbow flexion, forearm pronation, ulnar deviation and flexion of the wrist, and adduction-flexion posture of the thumb. Although only a relatively small subset of cerebral palsy patients are candidates for surgery, properly selected patients and procedures yield a reasonable improvement. Nonsurgical treatment modalities include physical therapy, orthoses, and medications aimed at decreasing spasticity. Surgical options for the management of the spastic upper extremity vary with the specific parts, however they are focused around three basic principles: weakening the overactive muscle/tendons, strengthening the underactive muscle/tendons, and stabilizing non-stable joints. Surgical management of the spastic upper limb in cerebral palsy requires meticulous evaluation and planning. It is important to know that upper extremity deformities are secondary manifestations of the cerebral injury. Therefore, in addition to evaluation of upper extremity function, consideration should be given to the intelligence and motivation of the patient, and voluntary use of the upper extremity. Prior to surgery, the overall level of function needs to be considered. These are also important details for the patients and their families, who should know that surgery is aimed at improving the upper extremity deformity, and not the primary disorder. Appropriately indicated surgery can significantly contribute to upper extremity function. (JAREM 2012; 2: 43-54) Key Words: Cerebral palsy, spasticity, upper extremity surgery, tendon transfers ÖZET Serebral paralizide üst ekstremite tutulumu, tipik bir spastisite paterni oluşturur. Bunun sonucunda da sıklıkla dirsek fleksiyonu, önkol pronasyonu, el bileğinde fleksiyon ve ulnar deviasyon, başparmakta adduksiyon-fleksiyon postürüyle karakterize bir deformite meydana gelir. Serebral paralizi hastalarının yalnızca az bir kısmı cerrahi için uygun adaylar olsa da, uygun seçilmiş hastalarda cerrahi tedavi yüz güldürücü sonuçlar verebilmektedir. Cerrahi dışı tedaviler arasında fizik tedavi, ortezler ve spastisiteyi azaltmaya yönelik ilaçlar vardır. Spastik üst ekstremite tedavisindeki cerrahi seçenekler deformitenin bulunduğu bölgeye göre değişir, ancak üç temel özellik üzerinde odaklanır: aşırı aktif kas ve tendonların zayıflatılması, yetersiz aktiviteye sahip olan kas ve tendonların güçlendirilmesi ve stabil olmayan eklemlerin stabilizasyonu. Dirsek fleksiyon deformitesi serebral paralizide nadiren bir cerrahi endikasyon oluşturur, ancak ileri derecede olup işlevi engellediğinde biceps ve brachialis gevşetilmesi, fleksor pronator kas kaydırma gibi işlemler ile düzeltilebilir. Önkol pronasyon postürü, supinasyon gerektiren, ele alınan bir cismin avuç içinde tutulması veya kişisel hijyen gibi görevlerin yapılama-masına neden olabilir. Bu durumlarda ideal olan, mevcut pronasyonu bozmadan hastaya supinasyon hareketi kazandırmaktır. Fleksor karpi ulnarisin ekstansor karpi radialis brevis'...

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Surgery for Cerebral Palsy Part 3: Classification and Operative Procedures for Thumb Deformity

Cited by 50 publications

References 11 publications

Upper limb function and deformity in cerebral palsy: a review of classification systems

Upper limb function and deformity in cerebral palsy: a review of classification systems

Adductor Tenotomy Combined with Palmar Capsulodesis for Spastic Thumb-in-Palm Deformity in Cerebral Palsy: Description of a Surgical Technique and Clinical Results

Upper Extremity Surgery in Spastic Cerebral Palsy

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