Postoperative physical therapy program for latissimus dorsi and teres major tendons transfer to rotator cuff in children with obstetrical brachial plexus injury.
BACKGROUND
The transfer of latissimus dorsi and teres major tendons to rotator cuff have been developed to rebalance the muscular dysfunction and improve shoulder range of motion in children with obstetrical brachial plexus palsy (OBPP). No previous study reported the ideal postoperative physical therapy program for these cases.


OBJECTIVE
The aim of the present study was to design appropriate postoperative physical therapy (PT) program after latissimus dorsi and teres major tendons transfer to rotator cuff in OBPP to improve upper limb function.


METHODS
Time series design.


METHODS
The patients were recruited from outpatient clinic of Kasr EL Aini Hospital, Cairo, Egypt.


METHODS
Forty seven OBPP infants (4.64±1.21 years with a range of 2.5 to 7 years, 21male and26 female) were allocated to one group. All patients had functional limitation in the involved arm due to muscle paralysis and contracture. Twenty-five patients had C5-C6 nerve root lesions while 22 had C5-C6-C7 nerve root lesions.


METHODS
The children underwent the surgical procedures of the transfer of latissimus dorsi and teres major tendons to rotator cuff. After the surgery the children participated in a designed physical therapy program for 6 months. Active shoulder abduction, flexion and external rotation range of motion (ROM) were assessed by electrogoniometer, and functional assessments were measured using the modified Mallet scale. All measurements were taken preoperative, 6 weeks, 3 months, and 6 months postoperatively after the application of the designed PT program.


RESULTS
Repeated measure analysis of variance (ANOVA) followed by Bonferroni post-hoc test were used to show the improvement in all measured variables. Analysis revealed that shoulder abduction, flexion and external rotation ROM and shoulder function measured by modified Mallet scale were significantly improved (P<0.0001) after the designed postoperative PT program.


CONCLUSIONS
It can be concluded that the combination treatment of surgical procedure and the postoperative physical therapy program seem to be effective in improving shoulder and arm functions in children with OBPP.


CONCLUSIONS
This study describes a detailed physical therapy program after latissimus dorsi and teres major tendons transfer to rotator cuff in OBPP.
Orthopedic Department, Faculty of Medicine, Kasr EL Aini Hospital, Cairo University, Cairo, Egypt.
Yasser A
YA
Safoury
Department of Basic Science, Faculty of Physical Therapy, Cairo University, Cairo, Egypt - mohamedtaher8@yahoo.com.
Mohamed T
MT
Eldesoky
Department of Basic Science, Faculty of Physical Therapy, Cairo University, Cairo, Egypt.
Enas E
EE
Abutaleb
Department of Physical Therapy, Faculty of Applied Medical Science, Hail University, Hail, Kingdom of Saudi Arabia.
Mohamed R
MR
Atteya
Department of Pediatric, Faculty of Physical Therapy, Cairo University, Cairo, Egypt.
Ahmed M
AM
Gabr
D001720:Birth Injuries / Q000150:complications / Q000601:surgery*; D001917:Brachial Plexus / Q000293:injuries; D020516:Brachial Plexus Neuropathies / Q000209:etiology / Q000534:rehabilitation*; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D010369:Pectoralis Muscles / Q000637:transplantation*; D026741:Physical Therapy Modalities; D011182:Postoperative Care; D017006:Rotator Cuff / Q000601:surgery*; D000070599:Shoulder Injuries; D012785:Shoulder Joint / Q000503:physiopathology / Q000601:surgery; D064171:Superficial Back Muscles / Q000637:transplantation*; D013709:Tendon Transfer / Q000379:methods*; D013997:Time Factors; D016896:Treatment Outcome