SCIENTIFIC ARTICLE Follow-Up Motion Laboratory Analysis for Patients With Spastic Hemiplegia Due to Cerebral Palsy: Analysis of the Flexor Carpi Ulnaris Firing Pattern Before and After Tendon Transfer Surgery Ann Van Heest, MD, Jean Stout, MS, Roy Wervey, BS, Louis Garcia, MD Purpose To compare the preoperative and postoperative pattern of firing of the flexor carpi ulnaris (FCU) in a grasp and release functional activity for children treated with an FCU to extensor carpi radialis brevis tendon transfer for wrist flexion deformity associated with spastic hemiplegia from cerebral palsy. Methods Seven children, evaluated by a preoperative EMG video analysis and treated with an FCU to extensor carpi radialis brevis transfer, had a follow-up postoperative EMG/video motion laboratory analysis at an average follow-up of 3.5 years (range, 1.0–6.8 years). Each preoperative and postoperative EMG/video was reviewed for the task of lifting heavy cans, as described by Jebson et al. The EMG activity of the FCU was described as active or relaxed during grasp and during release. Results Preoperatively, the most common pattern was to activate the FCU during grasp and to relax the FCU during release (4 patients). Postoperatively, 6 patients activated the FCU during grasp and relaxed the FCU during release; 1 patient activated the FCU during both grasp and release. Conclusions Of the 7 patients studied, the FCU changed phase from preoperative to postoperative in only 1. This study concludes that most commonly the FCU does not predictably change phase when transferred from a position of wrist flexion to wrist extension. (J Hand Surg 2010;35A:284–290. Copyright © 2010 by the American Society for Surgery of the Hand. All rights reserved.) Type of study/level of evidence Therapeutic IV. Key words Tendon transfer, cerebral palsy, motion laboratory analysis. C EREBRAL PALSY IS an upper motor neuron disor- der manifested by varying degrees of motor dysfunction, including muscle spasticity, mus- cle dystonia, muscle weakness, hyperreflexia, and loss of selective motor control. For the hand surgeon treat- ing upper extremity involvement of cerebral palsy, treatment will be focused on lengthening or transfers of specific muscles in the elbow, forearm, wrist, and hand. It is important for the hand surgeon to understand and characterize the type of involvement for specific muscle .units that are to be surgically treated. To gain a further understanding of the patterns of movement disorders present in cerebral palsy, video analysis with simulta- neous EMG assessment of electrical activity in the muscle has been used. 1 The EMG with simultaneous video analysis can be used to qualitatively assess the degree of selective motor control of the muscle tested and the activation pattern. Past studies have assessed the phase of activa- tion of muscles and whether muscles change phase From the Department of Orthopaedic Surgery, University of Minnesota, Minneapolis, Gillette Chil- dren’s Specialty Healthcare, St. Paul, MN; and San Ignacio University Hospital, Javeriana University, Bogota, Columbia. Received for publication October 19, 2007; accepted in revised form October 1, 2009. A MERA grant was received from the Gillette Children’s Specialty Care to all authors for completion of this research. No benefits in any form have been received or will be received related directly or indirectly to the subject of this article. Correspondingauthor: AnnVanHeest,MD,DepartmentofOrthopaedicSurgery,UniversityofMinne- sota, 2450 Riverside Avenue, Suite R200, Minneapolis, MN 55454; e-mail: vanhe003@umn.edu. 0363-5023/10/35A02-0018$36.00/0 doi:10.1016/j.jhsa.2009.10.004 284  ©  ASSH  Published by Elsevier, Inc. All rights reserved.