title: Glenohumeral Dysplasia Following Neonatal Brachial Plexus Palsy: Presentation and Predictive Features During Infancy.
abstract: OBJECTIVE
  To evaluate the presence and degree of glenohumeral dysplasia (GHD) in infants undergoing surgical exploration for neonatal brachial plexus palsy (NBPP) and to identify potential predictive factors of early maladaptive shoulder morphology.
  
  
  METHODS
  We included all consecutive patients with NBPP who underwent surgical exploration of their brachial plexus and who had a preoperative magnetic resonance imaging scan at our institution over a 3-year period. Demographic, therapy, and surgical data were collected. Imaging was reviewed for glenoid morphology, glenoid version, percent humeral head anterior to the scapula, and alpha angle.
  
  
  RESULTS
  Of 116 infants who presented to our institution during this 3-year period, 19 (16%) underwent surgical exploration and were included in the study. Median age at the time of the scan was 16 weeks (interquartile range, 14-46 weeks). Fourteen of 19 (74%) had GHD of Waters class 2 or increased malformation. Babies who had more severe palsies underwent earlier surgery and had less severe GHD at the time of surgery than did those with less severe palsies who had surgery later. Less severe GHD was associated with more severe palsies, as indicated by Narakas classification and number of root avulsions. Active external rotation was almost universally absent whereas other shoulder movements were present to varying degrees. More severe GHD was associated with greater total shoulder active range of motion and greater pectoralis major muscle mass.
  
  
  CONCLUSIONS
  Glenohumeral dysplasia occurs often and early in NBPP and may occur in the absence of restricted range of motion. Predictors include increasing age and factors related to muscular imbalance. As such, GHD likely affects the functional outcome that may be achieved with reinnervation, and early screening may improve outcomes.
  
  
  METHODS
  Prognostic IV.
authors.affiliation: Division of Plastic Surgery, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, MA.
authors.forename: Matthew L
authors.initials: ML
authors.lastname: Iorio
authors.affiliation: Department of Radiology, Seattle Children's Hospital, Seattle, WA.
authors.forename: Sarah J
authors.initials: SJ
authors.lastname: Menashe
authors.affiliation: Department of Radiology, Seattle Children's Hospital, Seattle, WA.
authors.forename: Ramesh S
authors.initials: RS
authors.lastname: Iyer
authors.affiliation: Department of Rehabilitation Medicine, Seattle Children's Hospital, Seattle, WA.
authors.forename: Sarah P
authors.initials: SP
authors.lastname: Lewis
authors.affiliation: Department of Orthopedics, Seattle Children's Hospital, Seattle, WA.
authors.forename: Suzanne
authors.initials: S
authors.lastname: Steinman
authors.affiliation: Seattle Children's Research Institute, Seattle Children's Hospital, Seattle, WA.
authors.forename: Kathryn B
authors.initials: KB
authors.lastname: Whitlock
authors.affiliation: Division of Plastic Surgery, Department of Surgery, Seattle Children's Hospital, Seattle, WA. Electronic address: raymond.tse@seattlechildrens.org.
authors.forename: Raymond W
authors.initials: RW
authors.lastname: Tse
mesh_terms: D001720:Birth Injuries / Q000175:diagnosis* / Q000601:surgery*; D020516:Brachial Plexus Neuropathies / Q000175:diagnosis* / Q000601:surgery*; D005260:Female; D006801:Humans; D007223:Infant; D008279:Magnetic Resonance Imaging; D008297:Male; D011237:Predictive Value of Tests; D012783:Shoulder Dislocation / Q000175:diagnosis* / Q000601:surgery*; D016896:Treatment Outcome
keywords: Glenohumeral dysplasia; brachial plexus injury; suprascapular nerve