Key result
Joint reduction, soft-tissue rebalancing, and tendon transfers in patients with brachial plexus birth palsy improved mean glenoid version from -33° to -7°.
Why the study?
The study aimed to investigate the importance of glenohumeral joint reduction combined with soft tissue release and tendon transfer for treating internal rotation contracture deformity of the shoulder in obstetric brachial plexus palsy.
Does joint reduction and tendon transfer improve glenohumeral joint morphology in patients with brachial plexus birth palsy and internal rotation contracture?
Cohort
No
Does joint reduction and tendon transfer improve glenohumeral joint morphology in patients with brachial plexus birth palsy and internal rotation contracture?
Tendon transfers combined with joint reduction improve shoulder function and glenohumeral joint remodeling in patients with brachial plexus birth palsy.
May support combined procedures for remodeling in brachial plexus birth palsy; leaves open need for randomized confirmation.
Background: Brachial plexus birth palsy (BPBP) occurs in 1.5 per 1,000 live births, resulting fromtraction to the brachial plexus during delivery. Surgical treatment of the secondary shoulder dysfunctionfollowing BPBP aims to accomplish three goals: restoration of passive motion by contracture release,realignment of dysplastic glenohumeral joint, and augmentation of muscle power in the weak domains ofshoulder movement. Objectives: To study the importance of reduction of the glenohumeral joint with softtissue release and tendon transfer in treatment of internal rotation contracure deformity of shoulder incases of O.B.P.P. Patients and methods: This prospective study was done in Microsurgery UnitOrthopedic department, Sohag University Hospitals including all patients with brachial plexus birthpalsy with internal rotation contracure of the shoulder with mild to moderate glenohumeral dysplasia.The patients included in this series had a diagnosis of brachial plexus birth palsy and glenohumeraldysplasia classified as type II, III, or IV on the Waters scale; had undergone joint reduction, soft-tissuerebalancing, and tendon transfers; and the average follow up was three years. Results: Mean glenoidversion improved from -33° to -7° following muscle rebalancing and soft-tissue releases. The percentageof the humeral head anterior to the middle of the glenoid improved from 8% to 43%. The averageduration of clinical and radiographic follow-up was thirty-six months; improvements in both shouldermotion and glenohumeral joint morphology were seen early and were maintained during the follow up < br />period. Conclusion: Latissimus dorsi and teres major tendon transfers to rotator cuff, combined withappropriate extra-articular musculotendinous lengthenings and joint reduction, result in improvedshoulder function and glenohumeral joint remodeling in the majority of patients with brachial plexusbirth palsy with mild to moderate dysplasia.
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Shiha et al. (2022) conducted a cohort in Brachial plexus birth palsy with internal rotation contracture and mild to moderate glenohumeral dysplasia. Joint reduction, soft-tissue rebalancing, and tendon transfers was evaluated on Glenoid version and percentage of the humeral head anterior to the middle of the glenoid. Joint reduction, soft-tissue rebalancing, and tendon transfers in patients with brachial plexus birth palsy improved mean glenoid version from -33° to -7°.
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