Spastic wrist flexion in cerebral palsy. Pronator teres versus flexor
					carpi ulnaris transfer

Bisneto, Edgard de Novaes França; Rizzi, Nivea; Setani, Eliana Ogassawara; Casagrande, Livia; Fonseca, Joseane; Fortes, Glaucia

doi:10.1590/1413-785220152303145550

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Acta Ortopédica Brasileira

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Original Articles • Acta ortop. bras. 23 (3) • May-Jun 2015 • https://doi.org/10.1590/1413-785220152303145550 copy

Spastic wrist flexion in cerebral palsy. Pronator teres versus flexor carpi ulnaris transfer

Authorship SCIMAGO INSTITUTIONS RANKINGS

OBJECTIVE:

Analize data on patients submitted to transfer of the pronator teres (PT) or the flexor carpi ulnaris (FCB) to the extensor carpi radialis longus/brevis (ECRL/B) in order to correct flexed wrist deformity in patients with cerebral palsy.

METHOD:

Patients were divided into two groups: PT group and FCU group to ECRL/B. The results were evaluated by goniometry and by the functional hand test (FHT).

RESULTS:

Goniometry showed a statistically significant difference in favor of FCU transfer. There was no statistically significant difference regarding FHT.

CONCLUSION:

Both transfers PT and FCU to ECRB are good options to correct wrist flexion deformity in cerebral palsy. Level of Evidence III, Non-randomized Controlled Cohort/Follow-Up Study.

Wrist; Cerebral palsy; Tendon transfer

Shoulder	Tenotomy of pectoralis major tendon
Elbow	Biceps to Triceps transfer
Elbow	Brachialis lengthening
Wrist	Flexor carpi radialis tendon z- lengthening
	Flexor digitorum superficilais tendon z-lengthening
	Palmaris longus to extensor pollicis brevis transfer
Hand	Tenotomy of the adductor pollicis tendon insertion

Goniometry	Up to 12 years old		12-15 years old		All patients
Goniometry	FCU	PT	FCU	PT	FCU	PT
Number of individuals in each group	3	3	6	16	15	22
Average of active extension	93.3	90.0	96.67	74.06	96.7	73.9
Median of active extension	90	90	90	90	90	90
Standard deviation	5.8	0	33.27	38.61	22.6	37.1
Minimum active extension	90	90	60	0	60	0
Maximum active extension	100	90	150	130	150	130
p-value	0.374		0.221		0.041

FHT	FCU		PR
FHT	Before	After	Before	After
Average value	34.5	51.2	37.3	47.5
Median	31	50	40	52
Standard deviation	15.0	14.4	19.9	17.7
Minimum value	4	23	5	12
Maximum value	53	85	64	78
Number of patients	13	13	18	18
p-value	<0.001		<0.001

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[1] Correspondence: Rua Dr. Ovídio Pires de Campos, 333, 3º andar, Sala 317-B, 054403-010 São Paulo, SP, Brazil. edgard.bisneto@hc.fm.usp.br

Level I	Walks without limitations
Level II	Walks with limitations
Level III	Walks using a hand-held mobility device
Level IV	Self-mobility with limitations; may use powered mobility
Level V	Transported in a manual wheelchair

Level I	Handles objects easily and successfully
Level II	Handles most objects but with somewhat reduced quality or speed of achievement
Level III	Handles objects with difficulty; needs help to prepare or modify activities
Level IV	Handles a limited selection of easily managed objects in adapted situations
Level V	Does not handle objects and has severely limited ability to perform even simple actions