All property rights in the material presented, including common-law copyright, are expressly reserved to the speaker or the ASSH. No statement or presentation made is to be regarded as dedicated to the public domain. IC02-L: The Spastic Upper Extremity: Contemporary Approaches Moderator(s): Peter C. Rhee, DO, MS Faculty: Lindley B. Wall, MD, Jennifer F. Waljee, MD, Caroline MC Leclercq, MD and Michael S. Bednar, MD Session Handouts 76 th Annual Meeting of the ASSH September 30 – October 2, 2021 822 West Washington Blvd Chicago, IL 60607 Phone: (312) 880-1900 Web: www.assh.org Email: [email protected]
Transcript
All property rights in the material presented, including common-law copyright, are expressly reserved to the speaker or the ASSH.
No statement or presentation made is to be regarded as dedicated to the public domain.
IC02-L: The Spastic Upper Extremity: Contemporary
Approaches
Moderator(s): Peter C. Rhee, DO, MS
Faculty: Lindley B. Wall, MD, Jennifer F. Waljee, MD, Caroline MC Leclercq, MD and Michael S. Bednar,
Washington University Orthopedics | St. Louis Children’s Hospital | Shriner’s Hospital for Children-St. Louis
Washington University Orthopedics
No Disclosures
Washington University Orthopedics | | St. Louis Children’s Hospital | Shriner’s Hospital for Children-St. Louis
Case
• 6 year-old female with hemiplegic CP. She has undergone botoxinjection and therapy for years. Not seeing improvement any longer. Primarily difficulty gripping
Washington University Orthopedics | | St. Louis Children’s Hospital | Shriner’s Hospital for Children-St. Louis Washington University Orthopedics | | St. Louis Children’s Hospital | Shriner’s Hospital for Children-St. Louis
9/7/21
2
Faculty opinion
• Approach?
Washington University Orthopedics | | St. Louis Children’s Hospital | Shriner’s Hospital for Children-St. Louis
Washington University Orthopedics | | St. Louis Children’s Hospital | Shriner’s Hospital for Children-St. Louis
Tendon transfer considerations
• Augments weak extensors•Don’t forget the finger flexors•Dynamic vs static transfer• Role of EMG
Washington University Orthopedics | | St. Louis Children’s Hospital | Shriner’s Hospital for Children-St. Louis
Technical considerations
• FCU origin is long = long incision for harvest• Ensure no fascial entrapment around ulna• Transfer through interosseous space• If worried about too much supination
• Transfer to ECRB or ECRL• Wrist in neutral
Washington University Orthopedics | | St. Louis Children’s Hospital | Shriner’s Hospital for Children-St. Louis
9/7/21
3
Tie in transfer at neutral*
Patterson et al. JHS 2010
Post-operative Rehabilitation
• Cast for 5 weeks• Wrist brace for 4 weeks with OT for gentle active motion• Young patients full time brace wear
• Brace nighttime for 3-4 weeks
Washington University Orthopedics | | St. Louis Children’s Hospital | Shriner’s Hospital for Children-St. Louis Washington University Orthopedics | | St. Louis Children’s Hospital | Shriner’s Hospital for Children-St. Louis
9/7/21
4
Thank you
Washington University Orthopedics | St. Louis Children’s Hospital | Shriner’s Hospital for Children-St. Louis
All property rights in the material presented, including common-law copyright, are expressly reserved to the speaker or the ASSH. No statement or presentation made is to be regarded as dedicated to the public domain.
Washington University Orthopedics | St. Louis Children’s Hospital | Shriner’s Hospital for Children-St. Louis
Washington University Orthopedics
No Disclosures
Washington University Orthopedics | | St. Louis Children’s Hospital | Shriner’s Hospital for Children-St. Louis
Case
• 6 year-old female with hemiplegic CP. She has undergone botoxinjection and therapy for years. Not seeing improvement any longer. Primarily difficulty gripping
Washington University Orthopedics | | St. Louis Children’s Hospital | Shriner’s Hospital for Children-St. Louis Washington University Orthopedics | | St. Louis Children’s Hospital | Shriner’s Hospital for Children-St. Louis
9/7/21
2
Faculty opinion
• Approach?
Washington University Orthopedics | | St. Louis Children’s Hospital | Shriner’s Hospital for Children-St. Louis
Washington University Orthopedics | | St. Louis Children’s Hospital | Shriner’s Hospital for Children-St. Louis
Tendon transfer considerations
• Augments weak extensors•Don’t forget the finger flexors•Dynamic vs static transfer• Role of EMG
Washington University Orthopedics | | St. Louis Children’s Hospital | Shriner’s Hospital for Children-St. Louis
Technical considerations
• FCU origin is long = long incision for harvest• Ensure no fascial entrapment around ulna• Transfer through interosseous space• If worried about too much supination
• Transfer to ECRB or ECRL• Wrist in neutral
Washington University Orthopedics | | St. Louis Children’s Hospital | Shriner’s Hospital for Children-St. Louis
9/7/21
3
Tie in transfer at neutral*
Patterson et al. JHS 2010
Post-operative Rehabilitation
• Cast for 5 weeks• Wrist brace for 4 weeks with OT for gentle active motion• Young patients full time brace wear
• Brace nighttime for 3-4 weeks
Washington University Orthopedics | | St. Louis Children’s Hospital | Shriner’s Hospital for Children-St. Louis Washington University Orthopedics | | St. Louis Children’s Hospital | Shriner’s Hospital for Children-St. Louis
9/7/21
4
Thank you
Washington University Orthopedics | St. Louis Children’s Hospital | Shriner’s Hospital for Children-St. Louis
All property rights in the material presented, including common-law copyright, are expressly reserved to the speaker or the ASSH. No statement or presentation made is to be regarded as dedicated to the public domain.
