Muscle & Tendon Procedures

Muscle contractures vary depending on the individual. Severity of longstanding spasticity and CP can cause muscles to become contracted. This means they become shorter and tighter over time. This can cause the joint to become stuck and can stop full motion.

 The wrist and elbow are very commonly affected. Muscles can be lengthened non surgically with stretching, botox and casting. Sugery can be considered when this is no longer effective. 

Muscles can be surgically lengthened by a number of methods called:

• Fractional lengthening: this is were the tendon is cut but the underlying muscle is allowed to stretch.

• “Z” lengthening: the tendon is cut along its length into 2 long halves these half can slide past each other and be stitched together in an elongated position. 

• Muscle slide - the muscle is released from its origin on the bone and is allowed to “slide” to a new position and become longer.

 Whilst surgical lengthening is very effective it may not achieve full correction as over time the bloods vessel and nerves usually also have become tight and unfortunately these cannot be lengthening surgically.

Tendon transfers may be considered in some cases where there are weak or paralysed muscles. The technique consists in rerouting a working muscle by bringing its tendon into the tendon of a weak or paralysed muscle.

. This can help to restore function and balance to the upper limb. The most common tendon transfers performed in upper limb CP are to improve the ability the lift up the wrist (ECU or FCU to ECRB transfer) or fingers up (transfer to EDC) and to bring the thumb up and out of the palm (transfer to EPL)

Not all patients are suitable for tendon transfers. Your surgeon will take many things into account when deciding whether this is suitable. Some examples of factors that may influence this are whether your child has the ability to control their muscles, how well the joint moves, the age of your child and whether they will be able to complete the rehabilitation. 

Sometimes an additional test called dynamic EMG may be organised to help determine whether your child has the ability to control the muscle that is going to be transferred. If they cannot control the muscle then the outcomes of surgery are more unpredictable, there is a risk of overcorrection or even creating a new problem.  

If the tendon is working but has been stretched out over a long time it may not need a transfer but can simply be redirected to have a better line of pull that is more efficient. This is often called a re-routing. 

After surgery the joint is normally immobilisation in a cast to protect the tendon repair for a number of weeks. After this prolonged period of physiotherapy is required. Good rehabilitation is an essential part of this treatment.