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Arthroscopic treatment of internal rotation contracture and glenohumeral dysplasia in children with brachial plexus birth palsy. 2010

Scott H Kozin, and Matthew J Boardman, and Ross S Chafetz, and Gerald R Williams, and Alexandra Hanlon
Department of Orthopaedic Surgery, Temple University & Hand Surgeon, Shriners Hospital for Children, Philadelphia, PA 19140, USA. skozin@shrinenet.org

BACKGROUND The purpose of the study was to assess the ability of arthroscopic anterior release, +/- tendon transfers to maintain shoulder joint alignment in children with brachial plexus palsy, and to assess their outcome after arthroscopic reduction. METHODS Forty-four patients underwent arthroscopic release, +/- tendon transfers to realign a dysplastic glenohumeral joint in children with brachial plexus palsy. Twenty-eight children underwent isolated release and 16 children underwent concomitant tendon transfers. MRI and clinical measurements were used to assess outcome at 1-year follow-up. RESULTS There was a significant improvement (P < .001) in both retroversion from -34 (+/-15) to -19 (+/-13), and percentage of the humeral head anterior to the middle of the glenoid fossa (PHHA) from 19% (+/-12%) to 33% (+/-12%), at 1 year. Passive external rotation increased from -26 (+/-20) degrees to 47 (+/-17) degrees (P < .001). Active elevation increased from 112 (+/-28) degrees to 130 (+/-38) (P = .008) degrees. Patients that underwent tendon transfers obtained greater active elevation, 147 (+/-9) degrees compared to 119 (+/-6) degrees. Mallet aggregate and domain scores also demonstrated statistically significant improvements. CONCLUSIONS Our results after arthroscopic release +/- tendon transfers are encouraging with improvements in joint alignment and clinical evaluations following surgery. The clinical improvements paralleled the MRI corrections. Importantly, superior outcomes were associated with better preoperative clinical and MRI status. This indicates that early recognition of glenohumeral dysplasia and timely intervention results in better shoulder motion and improved joint alignment. METHODS 4.

UI MeSH Term Description Entries
D007223 Infant A child between 1 and 23 months of age. Infants
D008279 Magnetic Resonance Imaging Non-invasive method of demonstrating internal anatomy based on the principle that atomic nuclei in a strong magnetic field absorb pulses of radiofrequency energy and emit them as radiowaves which can be reconstructed into computerized images. The concept includes proton spin tomographic techniques. Chemical Shift Imaging,MR Tomography,MRI Scans,MRI, Functional,Magnetic Resonance Image,Magnetic Resonance Imaging, Functional,Magnetization Transfer Contrast Imaging,NMR Imaging,NMR Tomography,Tomography, NMR,Tomography, Proton Spin,fMRI,Functional Magnetic Resonance Imaging,Imaging, Chemical Shift,Proton Spin Tomography,Spin Echo Imaging,Steady-State Free Precession MRI,Tomography, MR,Zeugmatography,Chemical Shift Imagings,Echo Imaging, Spin,Echo Imagings, Spin,Functional MRI,Functional MRIs,Image, Magnetic Resonance,Imaging, Magnetic Resonance,Imaging, NMR,Imaging, Spin Echo,Imagings, Chemical Shift,Imagings, Spin Echo,MRI Scan,MRIs, Functional,Magnetic Resonance Images,Resonance Image, Magnetic,Scan, MRI,Scans, MRI,Shift Imaging, Chemical,Shift Imagings, Chemical,Spin Echo Imagings,Steady State Free Precession MRI
D008297 Male Males
D011336 Probability The study of chance processes or the relative frequency characterizing a chance process. Probabilities
D001720 Birth Injuries Mechanical or anoxic trauma incurred by the infant during labor or delivery. Injuries, Birth,Birth Injury,Injury, Birth
D002648 Child A person 6 to 12 years of age. An individual 2 to 5 years old is CHILD, PRESCHOOL. Children
D002675 Child, Preschool A child between the ages of 2 and 5. Children, Preschool,Preschool Child,Preschool Children
D003286 Contracture Prolonged shortening of the muscle or other soft tissue around a joint, preventing movement of the joint. Contractures
D005260 Female Females
D005500 Follow-Up Studies Studies in which individuals or populations are followed to assess the outcome of exposures, procedures, or effects of a characteristic, e.g., occurrence of disease. Followup Studies,Follow Up Studies,Follow-Up Study,Followup Study,Studies, Follow-Up,Studies, Followup,Study, Follow-Up,Study, Followup

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