Clinical outcome of shoulder muscle transfer for shoulder deformities in obstetric brachial plexus palsy: A study of 150 cases

Abstract

Background:Residual muscle weakness, cross-innervation (caused by misdirected regenerating axons), and muscular imbalance are the main causes of internal rotation contractures leading to limitation of shoulder joint movement, glenoid dysplasia, and deformity in obstetric brachial plexus palsy. Muscle transfers and release of antagonistic muscles improve range of motion as well as halt or reverse the deterioration in the bony architecture of the shoulder joint. The aim of our study was to evaluate the clinical outcome of shoulder muscle transfer for shoulder abnormalities in obstetric brachial plexus palsy.Materials and Methods:One hundred and fifty patients of obstetric brachial plexus palsy with shoulder deformity underwent shoulder muscle transfer along with anterior shoulder release at our institutions from 1999 to 2007. Shoulder function was assessed both preoperatively and postoperatively using aggregate modified Mallet score and active and passive range of motion. The mean duration of follow-up was 4 years (2.5–8 years).Results:The mean preoperative abduction was 45° ± 7.12, mean passive external rotation was 10° ± 6.79, the mean active external rotation was 0°, and the mean aggregate modified Mallet score was 11.2 ± 1.41. At a mean follow-up of 4 years (2.5–8 years), the mean active abduction was 120° ± 18.01, the mean passive external rotation was 80° ± 10.26, while the mean active external rotation was 45° ± 3.84. The mean aggregate modified Mallet score was 19.2 ± 1.66.Conclusions:This procedure can thus be seen as a very effective tool to treat internal rotation and adduction contractures, achieve functional active abduction and external rotation, as well as possibly prevent glenohumeral dysplasia, though the long-term effects of this procedure may still have to be studied in detail clinico-radiologically to confirm this hypothesis.Level of evidence:Therapeutic level IV

Muscles Transfer around the Shoulder in Cases of Brachial Plexus Birth Palsy

“…On the other hand, our results are much nearer to this study coming from Bombay Hospital & Medical Research Centre in India at which the average age at the time of surgery was 44 months (range 18 months to 7 years) and this mostly due to the similar cultural circumstances [20].…”

A Method of Shoulder Spica Cast Application In Shoulder Muscle Transfer Patients In Supine Position

“…We have in the past published our results of shoulder muscle transfers where this spica has been used. 1 A standard wooden bar of breadth of around 3 to 4 inches could prove to be useful in most cases. A bigger size would be required for an overweight patient or adult patient.…”

The Surgical Strategy to Correct the Rotational Imbalance of the Glenohumeral Joint after Brachial Plexus Birth Injury

“…The available retrospective studies on the improvement of LR after obstetrical brachial plexus palsy (OBPP) with or without nerve or muscle transfer surgery unfortunately often do not mention which LR improved, unless they clearly relate to the drawings within the Mallet scale. 9,16,31 Others report only on aLR(ADD) 7 or aLR(ABD), 3 thus being incomplete.…”

“…Motion assessment in children is sometimes hazardous, not repeatable, or impossible when the child is not compliant. 2,9 For obvious ethic reasons, comparison with nonoperated control groups is rarely feasible in such a complex and impairing condition such as BPBI.…”

“…Recent papers [3][4][5][6][7][8][9] update the common knowledge on this problem and present postoperative results with variable follow-up periods.…”