Comparison of Arthroscopic Findings With Magnetic Resonance Imaging and Arthrography in Children With Glenohumeral Deformities Secondary to Brachial Plexus Birth Palsy

Arthroscopic treatment of posterior glenohumeral joint subluxation resulting from brachial plexus birth palsy

“…We assessed the status of the glenohumeral joint before and after arthroscopic surgery. We concur with Pearl et al 19 that the extent of the deformity is less apparent with arthroscopy compared with MRI. Arthroscopy reveals intraarticular topography indica- tive of abnormal development but is less informative than MRI with regard to the overall shape of the glenoid and alignment of the glenohumeral joint.…”

“…The deformed glenoid shape was also defined as either flat (retroverted), biconcave, or pseudoglenoid. 19,25 The PHHA was calculated by making a measurement at the widest portion of the humeral head, perpendicular to the line along the axis of the scapula. The width that the humeral head projected anterior to the axis line was divided by the total width of the head.…”

“…The incomplete recovery leads to muscle imbalance with strong internal rotators and weak external rotators, which results in an internal rotation contracture that is detrimental to glenohumeral joint development. 8,11,15,19,20,25 The constant position of internal rotation leads to early glenohumeral joint deformity by 6 months of age and advanced deformity by 2 years, which is characterized by increased glenoid retroversion and posterior humeral head subluxation. 1,3,7,11,14,16,21,24,25 Children with an established internal rotation contracture and glenohumeral joint deformity are unlikely to regain optimum shoulder function without intervention.…”

The Evaluation and Treatment of Children With Brachial Plexus Birth Palsy

“…Pearl and colleagues 19,20 had introduced a novel approach to the treatment of the internal rotation contracture associated with BPBP. They performed arthroscopic release of the anterior capsule and subscapularis tendon to reduce the glenohumeral joint, regain passive motion, and rebalance the surrounding forces.…”

Shoulder sequelae in children with brachial plexus palsy

“…13,14 These classifications show that with increasing deformity there is increasing posterior displacement of the humeral head from its normal concentric position, and the concave shape of the glenoid becomes increasingly convex. Pearl et al 15 found that there was strong agreement between arthrographic and MRI findings in patients with BPP and stressed the importance of preoperative imaging for all children with shoulder contractures to document the preoperative morphology of the glenohumeral joint, and for longitudinal followup of these patients postoperatively. This diagnostic information should be used in conjunc tion with physical examination to determine a sur gical plan for the patient.…”