Arthroscopic treatment of internal rotation contracture and glenohumeral dysplasia in children with brachial plexus birth palsy.
BACKGROUND
The purpose of the study was to assess the ability of arthroscopic anterior release, +/- tendon transfers to maintain shoulder joint alignment in children with brachial plexus palsy, and to assess their outcome after arthroscopic reduction.


METHODS
Forty-four patients underwent arthroscopic release, +/- tendon transfers to realign a dysplastic glenohumeral joint in children with brachial plexus palsy. Twenty-eight children underwent isolated release and 16 children underwent concomitant tendon transfers. MRI and clinical measurements were used to assess outcome at 1-year follow-up.


RESULTS
There was a significant improvement (P < .001) in both retroversion from -34 (+/-15) to -19 (+/-13), and percentage of the humeral head anterior to the middle of the glenoid fossa (PHHA) from 19% (+/-12%) to 33% (+/-12%), at 1 year. Passive external rotation increased from -26 (+/-20) degrees to 47 (+/-17) degrees (P < .001). Active elevation increased from 112 (+/-28) degrees to 130 (+/-38) (P = .008) degrees. Patients that underwent tendon transfers obtained greater active elevation, 147 (+/-9) degrees compared to 119 (+/-6) degrees. Mallet aggregate and domain scores also demonstrated statistically significant improvements.


CONCLUSIONS
Our results after arthroscopic release +/- tendon transfers are encouraging with improvements in joint alignment and clinical evaluations following surgery. The clinical improvements paralleled the MRI corrections. Importantly, superior outcomes were associated with better preoperative clinical and MRI status. This indicates that early recognition of glenohumeral dysplasia and timely intervention results in better shoulder motion and improved joint alignment.


METHODS
4.
Kozin
Scott H
SH
Department of Orthopaedic Surgery, Temple University & Hand Surgeon, Shriners Hospital for Children, Philadelphia, PA 19140, USA. skozin@shrinenet.org
Boardman
Matthew J
MJ
Chafetz
Ross S
RS
Williams
Gerald R
GR
Hanlon
Alexandra
A
D000704:Analysis of Variance; D001182:Arthroscopy / Q000379:methods*; D001720:Birth Injuries / Q000150:complications / Q000175:diagnosis; D020516:Brachial Plexus Neuropathies / Q000150:complications* / Q000175:diagnosis; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D003286:Contracture / Q000209:etiology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D016916:Joint Deformities, Acquired / Q000209:etiology / Q000601:surgery; D008279:Magnetic Resonance Imaging; D008297:Male; D019060:Minimally Invasive Surgical Procedures / Q000379:methods; D011336:Probability; D016059:Range of Motion, Articular / Q000502:physiology*; D020127:Recovery of Function; D012189:Retrospective Studies; D012785:Shoulder Joint / Q000503:physiopathology / Q000601:surgery*; D013709:Tendon Transfer / Q000379:methods*; D016896:Treatment Outcome