Long-term outcomes of selective adductor muscle release for House type 1 thumb-in-palm deformity in cerebral palsy

Abstract

Introduction:

This study retrospectively assessed the long-term outcomes of surgical treatment for House type 1 thumb-in-palm deformities in 25 patients with spastic hemiplegic cerebral palsy.

Methods:

The study included 25 patients (mean age: 12.8 years) who met the inclusion criteria. The surgical technique involved the release of spastic thumb adductors, enhancement of thumb abduction and extension and stabilization of the first metacarpophalangeal joint. Patients wore a below-elbow palmar splint with the first phalanx in abduction for 6 weeks, followed by static splinting between weeks 6 and 8, dynamic splinting and rehabilitation between weeks 8 and 16 and night splinting until month 6. The Manual Ability Classification System (MACS) scores and fine and gross grasping abilities were measured and compared with those on the contralateral side.

Results:

The mean follow-up period was 8.8 years. The MACS score decreased from 2.72 preoperatively to 1.56 in the long term. Marked improvements in grasping ability were observed: key-pinch improved by 19%, tip-to-pinch by 19.2%, triple-pinch by 19.5% and gross grasping by 37%.

Conclusion:

This study suggests that surgical treatment can improve long-term functional outcomes of thumb-in-palm deformities in patients with cerebral palsy.

Level of evidence: III, Therapeutic.