THE EFFECT OF TENDON TRANSFERS AND GLENOHUMERAL REDUCTION IN CASES OF O.B.P.P. WITH INTERNAL ROTATION CONTRACTURE

Document Type : Original articles: include clinical trials, interventional research, Basic researches and clinically relevant laboratory investigations

Authors

Orthopaedics and Traumatology dept., Faculty of Medicine, Sohag Univ., Sohag, Egypt

Abstract

Background: Brachial plexus birth palsy (BPBP) occurs in 1.5 per 1,000 live births, resulting from
traction to the brachial plexus during delivery. Surgical treatment of the secondary shoulder dysfunction
following BPBP aims to accomplish three goals: restoration of passive motion by contracture release,
realignment of dysplastic glenohumeral joint, and augmentation of muscle power in the weak domains of
shoulder movement. Objectives: To study the importance of reduction of the glenohumeral joint with soft
tissue release and tendon transfer in treatment of internal rotation contracure deformity of shoulder in
cases of O.B.P.P. Patients and methods: This prospective study was done in Microsurgery Unit
Orthopedic department, Sohag University Hospitals including all patients with brachial plexus birth
palsy with internal rotation contracure of the shoulder with mild to moderate glenohumeral dysplasia.
The patients included in this series had a diagnosis of brachial plexus birth palsy and glenohumeral
dysplasia classified as type II, III, or IV on the Waters scale; had undergone joint reduction, soft-tissue
rebalancing, and tendon transfers; and the average follow up was three years. Results: Mean glenoid
version improved from -33° to -7° following muscle rebalancing and soft-tissue releases. The percentage
of the humeral head anterior to the middle of the glenoid improved from 8% to 43%. The average
duration of clinical and radiographic follow-up was thirty-six months; improvements in both shoulder
motion and glenohumeral joint morphology were seen early and were maintained during the follow up < br />period. Conclusion: Latissimus dorsi and teres major tendon transfers to rotator cuff, combined with
appropriate extra-articular musculotendinous lengthenings and joint reduction, result in improved
shoulder function and glenohumeral joint remodeling in the majority of patients with brachial plexus
birth palsy with mild to moderate dysplasia.

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