Conceptos actuales en la parálisis braquial perinatal. Parte 2: etapa tardía. Deformidades en hombro

Abstract

RESUMENLa parálisis braquial tiene una incidencia relativamente alta, y sus secuelas son habituales. La rehabilitación, la microcirugía y las cirugías paliativas sobre partes blandas y huesos son utilizadas en forma conjunta. La postura más común del hombro es rotación interna y aducción, debido a la parálisis de los músculos antagonistas. El desequilibrio mantenido de fuerzas musculares sobre el sistema osteoarticular, determinará una deformidad progresiva glenohumeral que se estudia con resonancia magnética nuclear. La transferencia del dorsal ancho y redondo mayor al troquiter tiene buenos resultados, pero debe adelantarse y combinarse con liberación antero-inferior, si existe limitación de la movilidad pasiva. Palabras clave: secuela de parálisis braquial obsté-trica, parálisis obstétrica en etapa secuelar, secuela en parálisis braquial, displasia glenohumeral, transferencia tendinosa en hombro. ABSTRACTThe incidence of obstetric brachial palsy is high and their sequelaes are frequent. Physiotherapy, microsurgical nerve reconstruction and secondary corrections are used together to improve the shoulder function. The most common posture is shoulder in internal rotation and adduction, because of the antagonist weakness. The muscle forces imbalance over the osteoarticular system, will result in a progressive glenohumeral joint deformity which can be recognized with a magnetic resonance image. Tendon transfers of the internal rotators towards the external abductor/rotator muscles, has good results, but has to be combined with antero-inferior soft-tissue releases, if passive range of motion is limited. Key words: brachial plexus birth palsy, obstetrical palsy sequelae, shoulder sequelae in obstetric brachial plexus palsy, glenohumeral joint deformity, tendon transfer arround the shoulder.

Birth-related brachial plexus palsy (Erb-Duchenne palsy) 1 year after diagnosis. Clinical case

“…Tactile stimulation is important, as it allows recognition and cortical integration. These patients present a simultaneous contraction of the muscles, which occurs due to aberrant reinnervation due to spontaneous nerve regeneration 21 . This means that when contracting a muscle, the antagonist will do it the same way, and adequate active movement will not be carried out.…”