title: Surgical correction of shoulder rotation deformity in brachial plexus birth palsy: long-term results in 118 patients.
abstract: We present the long-term results of open surgery for internal shoulder rotational deformity in brachial plexus birth palsy (BPBP). From 1997 to 2005, 207 patients (107 females, 100 males, mean age 6.2 (0.6 to 34)) were operated on with subscapularis elongation and/or latissimus dorsi to infraspinatus transfer. Incongruent shoulder joints were relocated. The early results of these patients has been reported previously. We analysed 118 (64 females, 54 males, mean age 15.1 (7.6 to 34)) of the original patient cohort at a mean of 10.4 years (7.0 to 15.1) post-operatively. A third of patients with relocated joints had undergone secondary internal rotational osteotomy of the humerus. A mixed effects models approach was used to evaluate the effects of surgery on shoulder rotation, abduction, and the Mallet score. Independent factors were time (pre-and post-surgery), gender, age, joint category (congruent, relocated, relocated plus osteotomy) and whether or not a transfer had been performed. Data from a previously published short-term evaluation were reworked in order to obtain pre-operative values. The mean improvement in external rotation from pre-surgery to the long-term follow-up was 66.5° (95% confidence interval (CI) 61.5 to 71.6). The internal rotation had decreased by a mean of 22.6° (95% CI -18.7 to -26.5). The mean improvement in the three-grade aggregate Mallet score was 3.1 (95% CI 2.7 to 3.4), from 8.7 (95% CI 8.4 to 9.0) to 11.8 (11.5 to 12.1). Our results show that open subscapularis elongation achieves good long-term results for patients with BPBP and an internal rotation contracture, providing lasting joint congruency and resolution of the trumpet sign, but with a moderate mean loss of internal rotation.
authors.affiliation: Karolinska Institute, Department of Clinical Science and Education, Section for Hand Surgery, Södersjukhuset S-118 83 Stockholm, Sweden.
authors.forename: T
authors.initials: T
authors.lastname: Hultgren
authors.affiliation: Karolinska Institute, Department of Clinical Science and Education, Section for Hand Surgery, Södersjukhuset S-118 83 Stockholm, Sweden.
authors.forename: K
authors.initials: K
authors.lastname: Jönsson
authors.affiliation: Karolinska Institute, Department of Clinical Science and Education, Section for Hand Surgery, Södersjukhuset S-118 83 Stockholm, Sweden.
authors.forename: F
authors.initials: F
authors.lastname: Roos
authors.affiliation: Karolinska Institute, Department of Clinical Science and Education, Södersjukhuset S-118 83 Stockholm, Sweden.
authors.forename: H
authors.initials: H
authors.lastname: Järnbert-Pettersson
authors.affiliation: Karolinska Institute, Department of Clinical Science and Education, Section for Hand Surgery, Södersjukhuset S-118 83 Stockholm, Sweden.
authors.forename: H
authors.initials: H
authors.lastname: Hammarberg
mesh_terms: D000293:Adolescent; D000328:Adult; D001720:Birth Injuries / Q000150:complications* / Q000601:surgery; D001917:Brachial Plexus / Q000293:injuries*; 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; D010027:Osteotomy / Q000379:methods*; D016059:Range of Motion, Articular / Q000502:physiology*; D020127:Recovery of Function; D012189:Retrospective Studies; D012399:Rotation; D012785:Shoulder Joint / Q000503:physiopathology / Q000601:surgery*; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
keywords: Birth palsy; Brachial plexus; Long-term results; Rotational deformity; Shoulder