Treatment of Posterior Shoulder Dislocation in Obstetric Brachial Plexus Palsy Using Subscapularis Release and Tendon Transfer

Background: The muscle imbalance of the shoulder results in weak external rotation and abduction.Active internal rotation and adduction can cause glenohumeral joint deformity with late posterior dislocation.Patients and Methods: In this prospective study from 2004 to 2009, thirty four patients, 18 females and 16 males with mean age of 4 years (1-7 years).The right side was affected in 19 cases while the left side was affected in 15 cases.All patients were suffering from obstetrical brachial plexus palsy (OBPP) with internal rotation contracture and defective shoulder abduction plus posterior dislocation or subluxation of the humeral head.These patients were treated with soft tissue release (subscapularis slide and anterior soft tissues release) with or without tendon transfer (latissimus dorsi & teres major to infraspinatus). Conclusion:The subscapularis release can provide objective functional benefit, but this degraded over time.The transfer of teres major and latissimus dorsi to infraspinatus is a useful procedure for correction of defective shoulder abduction and external rotation in (OBPP) as it increases the stabilizing action of the rotator cuff allowing the deltoid muscle to act with maximal force.