Shoulder External Rotation Tendon Transfers For Brachial Plexus Birth Palsy

Abstract

Children with brachial plexus birth palsy may have permanent loss of shoulder external rotation strength. This impairment may result to a difficulty in reaching the face and head with the affected hand for grooming activities, and in reaching overhead for participation in sports or work-related tasks. In addition, the contracture that results from unopposed internal rotation may further restrict range of motion and cause glenohumeral joint deformity and subluxation.A combination of muscle release and transfers reliably improves the child's ability to position the hand, and may halt the development of joint deformity. Postoperative rehabilitation is necessary to maximize the strength and range of motion obtained from this operation.

Evaluation of infraspinatus reinnervation and function following spinal accessory nerve to suprascapular nerve transfer in adult traumatic brachial plexus injuries

“…In the pediatric BPI literature, restoration of ER is emphasized, while adult BPI reviews have reported primarily shoulder abduction data . Reports of infraspinatus function following the SAN to SSN nerve transfer are highly variable and often contradicting, ranging from 8% to 100% in UT injuries .…”

The Importance of Shoulder External Rotation in Activities of Daily Living: Improving Outcomes in Traumatic Brachial Plexus Palsy

“…In the absence of spontaneous nerve recovery, surgical efforts both early (plexus and nerve root exploration, nerve repair, grafts and transfers 1,2,4,5 ) and late (tendon transfers or free functioning muscle transfer 1,2,6,7,8 ) are typically directed at restoration of active elbow flexion and shoulder motion in an effort to restore the patient's ability to place the hand in a more functional position away from the body. 6,7,8 Despite multiple reports in the pediatric literature of successful tendon transfers and humeral osteotomies for brachial plexus birth palsy aimed at restoring shoulder external rotation, 9,10,11,12 the bulk of the adult traumatic brachial plexus palsy literature focuses on restoration of shoulder abduction and forward elevation. 8 A recent case report and small case series from 2 separate institutions, however, challenge this traditionally accepted focus, directing attention to restoration of shoulder external rotation.…”

Lésions anciennes des nerfs suprascapulaire, axillaire, accessoire et thoracique long

“…Le déficit de rotation externe du bras rend particulièrement difficile la préhension d'objets [4]. Lorsque la flexion du coude est normale, ce trouble fonctionnel est très mal toléré.…”