title: Outcome of secondary shoulder surgery in children with neonatal brachial plexus palsy with and without nerve surgery treatment history: A long-term follow-up study.
abstract: OBJECTIVE
  Irrespective of treatment history, shoulder dysfunction may occur in children with neonatal brachial plexus palsy. Following internal contracture release and/or muscle tendon transfer (ICR/MTT) shoulder function gain is possible. This study describes the outcomes of ICR/MTT for children with neonatal brachial plexus palsy, with or without prior nerve surgery (a group with prior nerve surgery and a group without prior nerve surgery).
  
  
  METHODS
  The study included children who underwent an ICR/MTT with a minimum follow-up of 6 months. Active/passive range of motion (aROM/pROM)/Mallet scores were recorded (pre-operatively, 6 months, and 1, 3, 5 and 10 years post-surgery). Changes over time within groups were analysed using a linear mixed model.
  
  
  RESULTS
  A total of 115 children (60 boys) were included, 82 with nerve surgery history, mean age 4.7 years (standard deviation (SD) 3.3 years), mean follow-up 6 years (SD 3.2 years). Pre-operatively active external rotation, abduction and forward-flexion were worse in the group with prior nerve surgery. aROM, pROM and Mallet scores, improved at all time-points in both groups. The course and magnitude of these improvements were largely similar in both groups. In the long-term, the effects of ICR/MTT decrease, but remain significant.
  
  
  CONCLUSIONS
  In children with neonatal brachial plexus palsy shoulder function improved after ICR/MTT, irrespective of treatment history. Pre-operative shoulder function was worse in the group with prior nerve surgery, resulting in less function in this group after ICR/MTT. Reporting on outcome after secondary shoulder surgery should be stratified into children with and without prior nerve surgery, in order to prevent over- or underestimation of results.
  
  
  METHODS
  This study concerned a retrospective treatment case series study.
  
  
  METHODS
  IV.
authors.affiliation: Department of Orthopaedics, Rehabilitation and Physical Therapy, Leiden University Medical Center, NL-2300 RC Leiden, The Netherlands. m.van_der_holst@lumc.nl.
authors.forename: Menno
authors.initials: M
authors.lastname: van der Holst
authors.forename: C W P Gerco
authors.initials: CW
authors.lastname: van der Wal
authors.forename: Ron
authors.initials: R
authors.lastname: Wolterbeek
authors.forename: Willem
authors.initials: W
authors.lastname: Pondaag
authors.forename: Thea P M
authors.initials: TP
authors.lastname: Vliet Vlieland
authors.forename: Rob G H H
authors.initials: RG
authors.lastname: Nelissen
mesh_terms: D020516:Brachial Plexus Neuropathies / Q000503:physiopathology / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D057913:Joint Capsule Release / Q000379:methods*; D008297:Male; D016059:Range of Motion, Articular / Q000502:physiology; D012086:Reoperation; D012189:Retrospective Studies; D012785:Shoulder Joint / Q000503:physiopathology / Q000601:surgery*; D013709:Tendon Transfer / Q000379:methods*; D016896:Treatment Outcome