Arthroscopic release of shoulder contracture secondary to birth palsy: an early report on findings and surgical technique.
OBJECTIVE
Internal rotation contractures are common in children with external rotation weakness secondary to brachial plexus birth palsy. Surgical release of the contracture, with or without latissimus dorsi transfer, is an established treatment through a variety of open methods. This article describes an arthroscopic method of contracture release in this patient population.


METHODS
New surgical technique.


METHODS
Forty-one children with contractures, ranging in age from 8 months to 12 years (mean, 3.5 years), underwent arthroscopic release of the shoulder with a 2.7-mm arthroscope used for visualization. The release consisted of a subscapularis tenotomy and release of the anterior capsular ligaments. Eighteen children underwent a subscapularis release as an isolated procedure. Twenty-three of the children also underwent latissimus dorsi transfer.


RESULTS
Arthroscopic release was successful in achieving at least 45 degrees of passive external rotation at surgery in all but one case. This case was in the oldest child, a 12-year-old with severe deformity, who needed an open release. No other complications were noted. Glenohumeral deformity was common. The primary contracted elements were the subscapularis and the anterior capsular ligaments.


CONCLUSIONS
Arthroscopic contracture release was effective in the restoration of passive external rotation in children with internal rotation contractures secondary to birth palsy.
Pearl
Michael L
ML
Center for Medical Education, Department of Orthopaedic Surgery, Kaiser Permanente Los Angeles Medical Center, Los Angeles, California 90027, USA. Michael.L.Pearl@KP.org
D001182:Arthroscopy / Q000379:methods*; D001720:Birth Injuries / Q000601:surgery*; D020516:Brachial Plexus Neuropathies / Q000150:complications / Q000151:congenital / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D003286:Contracture / Q000209:etiology / Q000601:surgery*; D019299:Decompression, Surgical / Q000379:methods*; D005260:Female; D006801:Humans; D007223:Infant; D008022:Ligaments / Q000601:surgery; D008297:Male; D018482:Muscle, Skeletal / Q000637:transplantation; D012399:Rotation; D012785:Shoulder Joint / Q000601:surgery*; D013710:Tendons / Q000601:surgery; D016896:Treatment Outcome