title: Transfer of latissmus dorsi and teres major tendons without subscapularis release for the treatment of obstetrical brachial plexus palsy sequela.
abstract: BACKGROUND
  Patients with obstetrical brachial plexus palsy (OBPP) sequela exhibit adduction and internal rotation contractures. The muscular imbalance may result in secondary bony changes. Tendon transfers and muscular releases may improve shoulder function in these patients. The aim of this study is to evaluate the functional and radiological results of pectoralis major tendon Z-plasty with transfer of latissimus dorsi and teres major tendons to rotator cuff tendons without release of subscapularis muscle in patients with mild sequela of OBPP.
  
  
  METHODS
  Twenty-six consecutive patients, who were treated with tendon transfer and met the eligibility criteria, were included in the study. No additional humeral osteotomy or subscapularis tenotomy was performed. Functional evaluation is made according to range of motion and Mallet scoring system. Preoperative radiologic evaluation was made according to the grading system of Waters.
  
  
  RESULTS
  A significant increase in shoulder function was found in all patients. Postoperative radiographs revealed glenohumeral congruity was maintained in all patients. Improvement in shoulder abduction and external rotation was higher in patients who were operated before the age of 7.
  
  
  CONCLUSIONS
  Pectoralis major tendon lengthening with transfer of latissimus dorsi and teres major tendons to rotator cuff is an effective and reproducible technique and can improve shoulder functions in patients with OBPP. Subscapularis release is not always required to overcome internal rotation contracture. Secondary glenohumeral changes might also be prevented with this approach.
authors: Department of Orthopaedics and Traumatology, Istanbul University, Istanbul Medical Faculty, Istanbul, Turkey.
authors: Hakan
authors: H
authors: Ozben
authors: Ata Can
authors: AC
authors: Atalar
authors: Kerem
authors: K
authors: Bilsel
authors: Mehmet
authors: M
authors: Demirhan
mesh_terms: D000293:Adolescent; D001720:Birth Injuries / Q000150:complications* / Q000503:physiopathology / Q000601:surgery; D001917:Brachial Plexus / Q000293:injuries / Q000503:physiopathology / Q000601:surgery*; D020516:Brachial Plexus Neuropathies / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D008297:Male; D018482:Muscle, Skeletal / Q000503:physiopathology / Q000601:surgery*; D010027:Osteotomy / Q000379:methods*; D010369:Pectoralis Muscles / Q000503:physiopathology / Q000601:surgery; D016059:Range of Motion, Articular; D012785:Shoulder Joint / Q000503:physiopathology / Q000601:surgery; D013709:Tendon Transfer / Q000379:methods*; D013997:Time Factors; D016896:Treatment Outcome