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Arthroscopic Treatment of Internal Rotation Contracture and Glenohumeral Dysplasia In Brachial Plexus Birth Palsy

Saturday, October 20, 2012: 9:00 AM
Melrose (Hilton Riverside)
Joshua M. Abzug, MD1, Scott H. Kozin2, Dan A. Zlotolow2, Alexis Williams, BS3 and Gerald Williams, MD4, (1)Orthopaedic Surgery, University of Maryland, Timonium, MD, (2)Orthopaedic Surgery, Shriners Hospital for Children Philadelphia, Deptford, NJ, (3)Shriners Hospital for Children, Philadelphia, PA, (4)Orthopaedic Surgery, Thomas Jefferson College of Medicine, Philadelphia, PA

Purpose: The purpose of this study was to report on the one and three year radiographic and clinical outcomes of children who underwent arthroscopic anterior release, with or without tendon transfer, to maintain shoulder joint alignment in children with brachial plexus birth palsy (BPBP). 

Methods: Forty-four patients who underwent arthroscopic release, with or without tendon transfers, for glenohumeral dysplasia in children with BPBP were prospectively followed for a minimum of three years.  Clinical data included active abduction, external rotation, and Mallet scores.  MRI data included the amount of retroversion and the percentage of the humeral head anterior to the middle of the glenoid fossa (PHHA). All data points were collected pre-operatively, and at one and three years post-operatively.

Results: Retroversion improved from -34° pre-operatively to -19° at one year and -14° at three years. PHHA improved from 19% pre-operatively to 33% at one year and 36% at three years.   Passive external rotation improved from -26° preoperatively to 48°at one year, and 49° at three years.   Active abduction improved from 112° preoperatively to 130° at one year and 132° at three years.  Individual Mallet components were significantly improved for external rotation, hand to neck, and hand to mouth when comparing preoperative scores to those at one and three years.

Conclusion: Arthroscopic anterior release, with or without tendon transfers, results in improved glenohumeral alignment and joint remodeling. The positive post-operative outcomes found at one year were successfully maintained at 3 year follow-up. We believe that prompt recognition, timely diagnosis, and early surgical intervention results in a better aligned joint and superior function.  Arthroscopic release is easier in the young child with less deformity compared to an older shoulder with severe joint subluxation and glenoid retroversion. In addition, less subscapularis release is required to obtain joint reduction, which preserves midline function.