Spastic elbow deformities lead to upper extremity dysfunction in children with cerebral palsy. Walking and running often exacerbate the posture. While non-operative measures are helpful to diminish the contracture, improvement is typically not long lasting. The authors report on 42 elbow releases in 40 children with cerebral palsy. The cohort consisted of individuals with hemiplegia (22), quadriplegia (20), and 14 with “notable” athetosis. A uniform surgical approach was performed with division of the lacertus fibrosis, fractional lengthening of the brachialis, and denuding of the peritendinous adventitia from the biceps tendon to remove afferent nerve fibers and receptors. Results revealed improvement in flexion posture from 104 to 55 degrees. Active extension improved from 43 degrees to 27 degrees. There was no difference in outcome between athetoid and non-athetoid patients.
Elbow release in cerebral palsy is different than traumatic brain injury. Lengthening of the biceps tendon weakens foreman supination and exaggerates forearm pronation posture. Surgical release of the elbow flexors provides consistent improvement in elbow posture and function. The concept of improving the flexion posture by removing the peritendinous adventitia surrounding the biceps remains speculative. This concept deserves further study.
Journal of Pediatric Orthopaedics