Incidence of early posterior shoulder dislocation in brachial plexus birth palsy

Abstract

BackgroundPosterior dislocation of the shoulder in brachial plexus birth palsy during the first year of life is rare but the incidence increases with age. The aim was to calculate the incidence of these lesions in children below one year of age.MethodsThe incidence of brachial plexus birth lesion and occurrence of posterior shoulder dislocation was calculated based on a prospective follow up of all brachial plexus patients at an age below one in Malmö municipality, Sweden, 2000–2005.ResultsThe incidence of brachial plexus birth palsy was 3.8/1000 living infants and year with a corresponding incidence of posterior shoulder dislocation (history, clinical examination and x-ray) during the first year of 0.28/1000 living infants and year, i.e. 7.3% of all brachial plexus birth palsies.ConclusionAll children with a brachial plexus birth lesion (incidence 3.8‰) should be screened, above the assessment of neurological recovery, during the first year of life for posterior dislocation of the shoulder (incidence 0.28‰) since such a condition may occur in 7% of children with a brachial plexus birth lesion.

External Rotation Predicts Outcomes After Closed Glenohumeral Joint Reduction With Botulinum Toxin Type A in Brachial Plexus Birth Palsy

“…[12][13][14][15] Internal rotation posturing of the shoulder gradually forces the humeral head posteriorly due to weak active shoulder external rotation, loss of passive stretch, capsular contractures, and subsequent glenoid biconcavity or retroversion. 1,2,[16][17][18][19] If uncorrected, progressive glenohumeral dysplasia can lead to permanent shoulder deformity and limited motion.…”

The Surgical Strategy to Correct the Rotational Imbalance of the Glenohumeral Joint after Brachial Plexus Birth Injury

“…16 The GHJ incongruence regularly appears as a delayed progressive phenomenon, thus seeming secondary to the muscular imbalance, but may be present as early as within the first months of life. It has been clearly documented before 1 year of age, 1,17,18 but seems to be rare. In a prospective study, 7% of all BPBI suffered from a posterior shoulder dislocation before 1 year.…”

“…In a prospective study, 7% of all BPBI suffered from a posterior shoulder dislocation before 1 year. 17 Any peripartal direct trauma to the humeral head could end in a potentially unrecognized peripartal (neonatal) glenohumeral (sub)dislocation, 19 which needs an immediate orthopedic strategy, including a closed humeral head reposition and a plaster immobilization in LR with the arm in adduction.…”

Prevalence of Posterior Shoulder Subluxation in Children With Neonatal Brachial Plexus Palsy After Early Full Passive Range of Motion Exercises

“…Posterior shoulder subluxation (PSS) associated with neonatal brachial plexus palsy (NBPP) can result from musculoskeletal deformities of the shoulder joint due to persistent muscle weakness or imbalance. In the 0.4‐4.6 per 1000 live births affected by NBPP [1‐5], PSS has a reported prevalence of 25% in children with a mean age of 47 months [6]; likewise, the reported prevalence of osseous deformity is 33% in children with a mean age of 43 months [7]. Persistent PSS leads to structural changes in the glenohumeral joint, resulting in decreased function and pain in the upper extremity and an increased need for surgical intervention [8‐12].…”