Muscle transfers in children and adults improve external rotation in cases of obstetrical brachial plexus paralysis: a comparative study

Abstract

This technique improves external rotation and abduction of the shoulder for daily living activities in children and young, skeletally mature, patients.

Results of nerve reconstructions in treatment of obstetrical brachial plexus injuries

“…The procedure includes a surgical release of muscle contractures, tendon transfers, free-muscle transplantation and osteotomies. Surgery should be carried out after the age of 4 years when the child has ability to cooperate with rehabilitation and severe contractures are absent [15,6]. Although the present study contains a limited number of patients, our results demonstrate that improved function can be obtained for infants with obstetrical brachial plexus injury with early surgical reconstruction.…”

Long-term functional outcome of secondary shoulder surgery in brachial plexus birth palsy patients

“…20,31,37,40,42 The mean external rotation improvement ranged between 12° to 72° in the soft-tissue release group, 20,27,31,32,37,42 and between 29° and 128° in the soft-tissue lengthening group. 28,30,33,35,39,43 Since the surgical techniques are different, the groups cannot be compared. One study found preferable results after subscapularis release combined with a latissimus dorsi transfer compared to subscapularis release only.…”

“…19 To evaluate the correlation of age at surgery and radiological and functional outcome, eight studies performed a subgroup analysis. 28,30,33,35,36,38-40 Jönsson et al 36 described an improvement of glenoid version in all age subgroups (0 to 2, 2 to 5, and > 5 years) without significant differences between the groups after a subscapularis lengthening at ten-year follow-up. Additionally, five other studies described no differences in functional outcome regarding external rotation and abduction between different age subgroups.…”

“…20,31,37,40,42 the mean external rotation improvement ranged between 12° to 72° in the soft-tissue release group, 20,27,31,32,37,42 and between 29° and 128° in the soft-tissue lengthening group. 28,30,33,35,39,43 In all cases except one, the posterior dislocation was corrected.…”

“…Additionally, five other studies described no differences in functional outcome regarding external rotation and abduction between different age subgroups. 30,33,35,39,40 In contrast, one study described a statistically significant better mean abduction (6.1 vs 5.2 points, p < 0.001) in the active movement scale, better active abduction ROM (141° vs 118°, p = 0.001), and better Toronto scores (8.8 vs 7.7, p = 0.035) in patients operated at an age younger than 2.5 years, compared to patients operated at an age older than 2.5 years. 28 There was no difference in external rotation between the groups in this study.…”