Treatment of shoulder sequelae in brachial plexus birth injury

Autor: Antti Lamminen, Patrick J Willamo, Yrjänä Nietosvaara, Tiina H. Pöyhiä, Jari Peltonen
Přispěvatelé: Department of Diagnostics and Therapeutics, Children's Hospital, Lastenkirurgian yksikkö, HUS Children and Adolescents
Rok vydání: 2011
Předmět:
PARALYSIS
medicine.medical_treatment
CHILDREN
TENDON TRANSFERS
Osteotomy
0302 clinical medicine
3123 Gynaecology and paediatrics
Paralysis
Orthopedics and Sports Medicine
DYSPLASIA
Range of Motion
Articular
Child
GLENOID VERSION
030222 orthopedics
medicine.diagnostic_test
GLENOHUMERAL DEFORMITY
Shoulder Joint
General Medicine
PALSY SECONDARY
medicine.anatomical_structure
Treatment Outcome
Child
Preschool
DISLOCATION
medicine.symptom
Range of motion
musculoskeletal diseases
Reoperation
medicine.medical_specialty
Adolescent
education
ROTATION OSTEOTOMY
Article
03 medical and health sciences
Birth Injuries
medicine
Humans
Humerus
Brachial Plexus
business.industry
Shoulder Dislocation
Infant
Newborn
Magnetic resonance imaging
medicine.disease
Birth injury
Surgery
Shoulder joint
HUMERAL HEAD
business
Brachial plexus
030217 neurology & neurosurgery
Follow-Up Studies
Zdroj: Acta Orthopaedica
ISSN: 1745-3682
Popis: Background Many children with permanent brachial plexus birth injury (BPBI) develop shoulder problems, with subsequent joint deformity without treatment. We assessed the indications and outcome of shoulder operations for BPBI. Patients and methods 31 BPBI patients who had undergone a shoulder operation in our hospital between March 2002 and December 2005 were included in the study. Relocation of the humeral head had been performed in 13 patients, external rotation osteotomy of the humerus in 5 patients, subscapular tendon lengthening in 5 patients, and teres major transposition in 8 patients. Subjective results were registered. Shoulder range of motion was measured, and function assessed according to the Mallet scale. Magnetic resonance imaging (MRI) was performed pre- and postoperatively. Glenoscapular angle (GSA) and percentage of humeral head anterior to the middle of the glenoid fossa (PHHA) were measured. Congruency of the glenohumeral joint (GHJ) was estimated. The mean follow-up time was 3.8 (1.7–6.8) years. Results At follow-up, the subjective result was satisfactory in 30 of the 31 patients. There were 4 failures, which in retrospect were due to wrong choice of surgical method in 3 of these 4 patients. Mean increase in Mallet score was 5.5 after successful relocation, 1.4 after rotation osteotomy, 2.2 after subscapular tendon lengthening, and 3.1 after teres major transposition. Congruency of the shoulder joint improved in 10 of 13 patients who had undergone a relocation operation, with mean improvement in GSA of 33º and mean increase in PHHA of 25%. There were no substantial changes in congruency of the glenohumeral joint in patients treated with other operation types. Interpretation Restriction of the range of motion and malposition of the glenohumeral joint can be improved surgically in brachial plexus birth injury. Remodeling of the joint takes place after successful relocation of the humeral head in young patients.
Databáze: OpenAIRE
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