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

Abstract

In upper brachial plexus birth injury, rotational balance of the glenohumeral joint is frequently affected and contracture in medial rotation of the arm develops, due to a severe palsy or insufficient recovery of the lateral rotators. Some of these children present with a severe glenohumeral joint contracture in the first months, although regular physiotherapy has been provided, a condition associated with a posteriorly subdislocated or dislocated humeral head. These conditions should be screened early by a pediatrician or specialized physiotherapist. Both aspects of muscular weakness affecting the lateral rotators and the initial or progressive glenohumeral deformity and/or subdislocation must be identified and treated accordingly, focusing on the reestablishment of joint congruence and strengthening of the lateral rotators to improve rotational balance, thus working against joint dysplasia and loss of motor function of the shoulder in a growing child. Our treatment strategy adapted over the last 20 years to results from retrospective studies, including biomechanical aspects on muscular imbalance and tendon transfers. With this review, we confront our actual concept to recent literature.

The Pathogenesis of Glenohumeral Deformity and Contracture Formation in Obstetric Brachial Plexus Palsy—A Review

“…While there is a vast clinical knowledge about treatment of complications after OBPP, 10 61 62 the research focus shifted in the recent years to the etiology of GHD and shoulder contractures.…”

“…The biomechanics of the pathologic force vectors acting upon the glenohumeral contact area, which are likely to be involved in development of the shoulder deformity (the backward movement of the humeral head occurring with shoulder internal contracture), have been studied, including pilot studies employing multifactorial motion analysis to combine range of motion (ROM), muscle activity, forces, and torque acting on the glenohumeral joint in children with OBPP. 10 25…”

“…GHD is a set of skeletal alterations in the glenoid cavity and in the humeral head secondary to OBPP, which reversibility has not been clearly defined. 9 10…”

Oberlin transfer compared with nerve grafting for improving early supination in neonatal brachial plexus palsy

“…Anatomically, biceps muscle function could also be affected by surrounding shoulder or hand movements. 5,26,38,44,47,53 For infants with NBPP, impaired growth of denervated biceps muscle may lead to weakness or even contracture of the affected area. The process of muscle remodeling might reorganize the muscle structure such that infants with NBPP tend to compensate for the lack of biceps function with shoulder subscapularis or wrist muscles.…”