Improvement in abduction of the shoulder after reconstructive soft-tissue procedures in obstetric brachial plexus palsy

Abstract

Residual muscle weakness in obstetric brachial plexus palsy results in soft-tissue contractures which limit the functional range of movement and lead to progressive glenoid dysplasia and joint instability. We describe the results of surgical treatment in 98 patients (mean age 2.5 years, 0.5 to 9.0) for the correction of active abduction of the shoulder. The patients underwent transfer of the latissimus dorsi and teres major muscles, release of contractures of subscapularis pectoralis major and minor, and axillary nerve decompression and neurolysis (the modified Quad procedure). The transferred muscles were sutured to the teres minor muscle, not to a point of bony insertion. The mean pre-operative active abduction was 45 degrees (20 degrees to 90 degrees ). At a mean follow-up of 4.8 years (2.0 to 8.7), the mean active abduction was 162 degrees (100 degrees to 180 degrees ) while 77 (78.6%) of the patients had active abduction of 160 degrees or more. No decline in abduction was noted among the 29 patients (29.6%) followed up for six years or more. This procedure involving release of the contracted internal rotators of the shoulder combined with decompression and neurolysis of the axillary nerve greatly improves active abduction in young patients with muscle imbalance secondary to obstetric brachial plexus palsy.

Improvements after mod Quad and triangle tilt revision surgical procedures in obstetric brachial plexus palsy

“…Triangle tilt[20-28] and mod Quad procedures[14,31,32] have been demonstrated successful outcomes in OBPP.…”

Finger movement at birth in brachial plexus birth palsy

“…Nerve repair, modified Quad, and triangle tilt surgeries were performed on these patients by the senior author and the surgeon (Nath RK) as described previously [8][9][10][11] . Information regarding finger movement was obtained from the patient's parent or guardian during the initial evaluation.…”

Shoulder sequelae in children with brachial plexus palsy

“…Nath and Paizi 42,43 introduced the acronym SHEAR, which is used to refer to the deformity of scapular hypoplasia, eleva tion, and rotation. Interestingly, they postulated that this deformity was the cause rather than the result of internal rotation contractures and gleno humeral deformity and suggested a surgical proto col to address this deformity.…”

“…Interestingly, they postulated that this deformity was the cause rather than the result of internal rotation contractures and gleno humeral deformity and suggested a surgical proto col to address this deformity. 42,43 No additional studies have been conducted to substantiate this hypothesis.…”