scholarly journals Humeral Rotational Osteotomy for Shoulder Deformity in Obstetric Brachial Plexus Palsy: Which Direction Should I Rotate?

2014 ◽  
Vol 8 (1) ◽  
pp. 130-134 ◽  
Author(s):  
Amr A Abdelgawad ◽  
Miguel A Pirela-Cruz
Keyword(s):  
Brachial Plexus ◽  
Internal Rotation ◽  
Glenohumeral Joint ◽  
External Rotation ◽  
Brachial Plexus Palsy ◽  
Obstetric Brachial Plexus Palsy ◽  
Orthopedic Surgeons ◽  
Obstetric Brachial Plexus ◽  
Shoulder Deformity ◽  
Rotation Osteotomy

Shoulder internal rotation contracture is the most common deformity affecting the shoulder in patients with Obstetric Brachial Plexus Palsy. With progression of the deformity, the glenohumeral joint starts to subluxate and then dislocates. This is accompanied with bony changes of both the humerus and the glenoid. Two opposite direction humeral osteotomies have been proposed for this condition (internal rotation osteotomy (IRO) and external rotation osteotomy (ERO)). This fact of different direction osteotomies has not adequately been explained in the literature. Most orthopedic surgeons may not be able to fully differentiate between these two osteotomies regarding the indications, outcomes and effects on the joint. This review explains these differences in details.

scholarly journals Treatment approach to shoulder internal rotation deformity in children with obstetric brachial plexus palsy

2018 ◽  
Vol 6 (2) ◽  
pp. 22-28 ◽  
Author(s):  
Olga E. Agranovich ◽  
Anatoly B. Oreshkov ◽  
Evgeniya F. Mikiashvili
Keyword(s):  
Brachial Plexus ◽  
Internal Rotation ◽  
Upper Limb ◽  
Glenohumeral Joint ◽  
Brachial Plexus Palsy ◽  
Limb Function ◽  
Obstetric Brachial Plexus Palsy ◽  
Tendon Transfers ◽  
Upper Limb Function ◽  
Obstetric Brachial Plexus

Introduction. Shoulder internal rotation contracture is the most common deformity affecting the shoulder in patients with obstetric brachial plexus palsy because of the subsequent imbalance of the musculature and the abnormal deforming forces that cause dysplasia of the glenohumeral joint. Aim. To assess the effects of tendon transfers in children with shoulder internal rotation deformity due to obstetric brachial plexus palsy. Materials and methods. From 2015 to 2017, we examined and treated 15 patients with shoulder internal rotation deformity caused by obstetric brachial plexus palsy. The children ranged in age from 4 to 17 years. We used clinical and radiographic examination methods, including magnetic resonance imaging, electromyography, and electroneuromyography, of the upper limbs. Results. According to the level of plexus brachialis injury, the patients were divided into 3 groups: level С5–С6 (9 patients), level C5–C7 (5 children), level С5–Th1 (1 patient). All children had secondary shoulder deformities: glenohumeral dysplasia type II, 6 (40%); type III, 5 (34%); type IV, 1 (6%); and type V, 3 (20%). The Mallet score was used for estimation of upper limb function. Surgical treatment was performed in 15 children. After treatment, all patients showed improvement in activities of daily living. Conclusion. Tendon transfers in patients with shoulder internal rotation deformities due to obstetric brachial plexus palsy improved upper limb function and provided satisfactory cosmetic treatment results without of remodeling of the glenohumeral joint.

Latissimus Dorsi Transfer for External Rotation Weakness of the Shoulder in Obstetric Brachial Plexus Palsy

2003 ◽  
Vol 28 (5) ◽  
pp. 405-408 ◽  
Author(s):  
M. M. Al-QATTAN
Keyword(s):  
Brachial Plexus ◽  
Latissimus Dorsi ◽  
External Rotation ◽  
Skeletal Development ◽  
Shoulder Abduction ◽  
Brachial Plexus Palsy ◽  
Obstetric Brachial Plexus Palsy ◽  
Latissimus Dorsi Transfer ◽  
Obstetric Brachial Plexus ◽  
Shoulder External Rotation

This report describes the results of latissimus dorsi transfer for weakness of shoulder external rotation in 12 children with obstetric brachial plexus palsy. Selection criteria for the muscle transfer procedure included good passive external rotation of the shoulder, normal skeletal development of the shoulder joint, and adequate power of the deltoid. In addition to measuring the ranges of motion of joints before and after surgery, a modified Mallet grading system was utilized for the functional assessment of shoulder external rotation. At a mean follow-up of 4 years, two of the 12 children had recurrence of the shoulder deformity. In the remaining 10 children, the mean active external rotation was 30° (range, 20–60°), mean shoulder abduction was 140° (range, 90–170°), and all children had achieved a modified Mallet score of 4.

Obstetric Brachial Plexus Lesions: A Study of 74 Children Registered with the British Paediatric Surveillance Unit (March 1998–March 1999)

2003 ◽  
Vol 28 (1) ◽  
pp. 40-45 ◽  
Author(s):  
G. L. BISINELLA ◽  
R. BIRCH
Keyword(s):  
Brachial Plexus ◽  
Upper Limb ◽  
Surgical Correction ◽  
Brachial Plexus Palsy ◽  
Obstetric Brachial Plexus Palsy ◽  
Good Function ◽  
Secondary Deformity ◽  
Obstetric Brachial Plexus ◽  
Shoulder Deformity ◽  
Surveillance Unit

Seventy-four children with obstetric brachial plexus palsy registered with the British Paediatric Surveillance Unit were prospectively followed for a minimum of 2 years. Thirty-nine (52.7%) spontaneously recovered to normal or nearly normal levels and a further 29 (39.3%) regained good function in the upper limb. The most important secondary deformity involved the gleno-humeral joint and 20 patients (27%) needed surgical correction. Two more children await operation for shoulder deformity. The brachial plexus was explored in nine patients (12.2%) and repaired in seven.

Long-Term Results of Low Rotation Humeral Osteotomy in Children with Erb’s Obstetric Brachial Plexus Palsy

2009 ◽  
Vol 34 (4) ◽  
pp. 486-492 ◽  
Author(s):  
M. M. AL-QATTAN ◽  
H. AL-HUSAINAN ◽  
A. AL-OTAIBI ◽  
M. S. EL-SHARKAWY
Keyword(s):  
Brachial Plexus ◽  
Internal Rotation ◽  
Long Term Results ◽  
Shoulder Abduction ◽  
Brachial Plexus Palsy ◽  
Extension Deficit ◽  
Obstetric Brachial Plexus Palsy ◽  
Long Term Follow Up ◽  
Obstetric Brachial Plexus

Seventeen children with Erb’s (C5/6 and C5/6/7 types) obstetric brachial plexus palsy who underwent low rotation humeral osteotomy to treat internal rotation contracture of the shoulder were recalled back to the clinic at a mean of 10 (range 8–14) years after surgery. Eight were male and nine female with mean age of 16 (range 13–20) years. The osteotomy procedure was done at a mean age of 6 (range 5–8) years. Preoperative, early postoperative, and late postoperative motor assessments were compared. There was no recurrence of the internal rotation posturing of the shoulder and there was maintenance of the improvements in elbow extension deficit and forearm rotation. The most surprising finding was a significant ( P = 0.003) decrease in shoulder abduction on long-term follow-up (the mean shoulder abduction was 135 °, 146° and 109° measured pre-, early post- and late postoperatively, respectively). There was no correlation between changes in shoulder abduction and the radiological score of the shoulder.

Obstetric Brachial Plexus Palsy in Newborn Babies of Diabetic and Non-Diabetic Mothers

2010 ◽  
Vol 35 (5) ◽  
pp. 362-365 ◽  
Author(s):  
M.M. Al-Qattan ◽  
A.A.F. El-Sayed ◽  
A.Y. Al-Zahrani ◽  
S.A. Al-Mutairi ◽  
M.S. Al-Harbi ◽  
...  
Keyword(s):  
Brachial Plexus ◽  
Spontaneous Recovery ◽  
External Rotation ◽  
Elbow Flexion ◽  
Motor Power ◽  
Brachial Plexus Palsy ◽  
Obstetric Brachial Plexus Palsy ◽  
Obstetric Brachial Plexus ◽  
Shoulder External Rotation ◽  
Diabetic Mothers

Compared to non-diabetic mothers, diabetic mothers are known to deliver larger babies who are at higher risk for shoulder dystocia and obstetric brachial plexus palsy. The intrapartum forces applied during delivery of larger babies are expected to be higher. Hence, the chances of these babies for good spontaneous recovery are expected to be lower; and this is a generally believed hypothesis. The objective of this retrospective study was to compare obstetric brachial plexus palsy in newborn babies of diabetic and non-diabetic mothers. There were a total of 655 cases of obstetric palsy: 253 cases with diabetic mothers and 402 with non-diabetic mothers. The former were more likely to develop total palsy while the latter were more likely to develop extended Erb’s palsy. Newborn babies of diabetic mothers had significantly larger birth weights than those of non-diabetic mothers regardless of the type of palsy. The rate of good spontaneous recovery of the motor power of the limb in the two groups was not significantly different except in total palsy cases for shoulder external rotation and elbow flexion where the recovery was significantly better in the diabetic group. It was concluded that the generally believed hypothesis is not correct if one compares the outcome in the diabetic and non-diabetic groups for each type of palsy.

Sign in / Sign up

Export Citation Format

Share Document