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Azer A, Mendiratta D, Saad A, Duan Y, Cedarstrand M, Chinta S, Hanna A, Shihora D, McGrath A, Chu A. Outcomes of humeral osteotomies versus soft-tissue procedures in secondary surgical procedures for neonatal brachial plexus palsy: a meta-analysis. Front Surg 2023; 10:1267064. [PMID: 38033527 PMCID: PMC10685892 DOI: 10.3389/fsurg.2023.1267064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Accepted: 10/23/2023] [Indexed: 12/02/2023] Open
Abstract
Secondary surgical procedures can be used in brachial plexus birth injury to correct shoulder movement imbalances. This study compares outcomes of the two secondary surgical procedure types: humeral osteotomies and soft tissue procedures. Outcome measures assessed included active and passive internal and external rotation, active and passive abduction and adduction, active and passive flexion and extension, percentage of the humeral head anterior to the middle glenoid fossa, glenoid version, and Mallet Score. Nineteen full-text articles were included in the analysis. Humeral osteotomies resulted in a loss of internal rotation postoperatively (-15.94°). Active internal rotation was not evaluated for soft tissue procedures. All other assessed outcomes were improved postoperatively for bony and soft tissue procedures. Bony procedures exhibited a greater degree of active external rotation postoperatively when compared to soft tissue procedures (+67° vs. +40°). Both bony and soft tissue procedures Improve shoulder function in children with neonatal brachial plexus palsy, however, soft tissue procedures showed greater consistency in outcomes. Level of Evidence: IV.
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Affiliation(s)
- Amanda Azer
- Rutgers New Jersey Medical School, Newark, NJ, United States
| | | | - Anthony Saad
- Rutgers New Jersey Medical School, Newark, NJ, United States
| | - Yajie Duan
- Department of Statistics, Rutgers University, Newark, NJ, United States
| | - Matthew Cedarstrand
- Department of Orthopaedics, Rutgers New Jersey Medical School, Newark, NJ, United States
| | - Sree Chinta
- Rutgers New Jersey Medical School, Newark, NJ, United States
| | - Aedan Hanna
- Rutgers New Jersey Medical School, Newark, NJ, United States
| | - Dhvani Shihora
- Rutgers New Jersey Medical School, Newark, NJ, United States
| | - Aleksandra McGrath
- Department of Clinical Sciences, Umeå- University, Umeå, Sweden
- Department of Surgical and Perioperative Sciences, Umeå University, Umeå, Sweden
| | - Alice Chu
- Department of Orthopaedics, Rutgers New Jersey Medical School, Newark, NJ, United States
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Imam N, Sudah SY, Manzi JE, Michel CR, Pizzo DM, Menendez ME, Nicholson AD. Pediatric Shoulder Arthroscopy is Effective and Most Commonly Indicated for Instability, Obstetric Brachial Plexus Palsy, and Partial Rotator Cuff Tears. Arthrosc Sports Med Rehabil 2023; 5:e281-e295. [PMID: 36866288 PMCID: PMC9971909 DOI: 10.1016/j.asmr.2022.11.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2022] [Accepted: 11/09/2022] [Indexed: 01/03/2023] Open
Abstract
Purpose The purpose of this review was to systematically evaluate the literature on pediatric shoulder arthroscopy and outline its indications, outcomes, and complications. Methods This systematic review was carried out in accordance with PRISMA guidelines. PubMed, Cochrane Library, ScienceDirect, and OVID Medline were searched for studies reporting the indications, outcomes, or complications in patients undergoing shoulder arthroscopy under the age of 18 years. Reviews, case reports, and letters to the editor were excluded. Data extracted included surgical techniques, indications, preoperative and postoperative functional and radiographic outcomes, and complications. The methodological quality of included studies was evaluated using the Methodological Index for Non-Randomized Studies (MINORS) tool. Results Eighteen studies, with a mean MINORS score of 11.4/16, were identified, including a total of 761 shoulders (754 patients). Weighted average age was 13.6 years (range, 0.83-18.8 years) with a mean follow-up time of 34.6 months (range, 6-115). As part of their inclusion criteria, 6 studies (230 patients) recruited patients with anterior shoulder instability and 3 studies recruited patients with posterior shoulder instability (80 patients). Other indications for shoulder arthroscopy included obstetric brachial plexus palsy (157 patients) and rotator cuff tears (30 patients). Studies reported a significant improvement in functional outcomes for arthroscopy indicated for shoulder instability and obstetric brachial plexus palsy. A significant improvement was also noted in radiographic outcomes and range of motion for obstetric brachial plexus palsy patients. The overall rate of complication ranged from 0% to 25%, with 2 studies reporting no complications. The most common complication was recurrent instability (38 patients of 228 [16.7%]). Fourteen of the 38 patients (36.8%) underwent reoperation. Conclusion Among pediatric patients, shoulder arthroscopy was indicated most commonly for instability, followed by brachial plexus birth palsy, and partial rotator cuff tears. Its use resulted in good clinical and radiographic outcomes with limited complications. Level of Evidence Systematic review of Level II to IV studies.
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Affiliation(s)
- Nareena Imam
- Robert Wood Johnson Medical School, New Brunswick Chicago, Illinois, U.S.A.,Address correspondence to Nareena Imam, B.A., Robert Wood Johnson Medical School, 125 Paterson Street, New Brunswick, NJ 08901.
| | - Suleiman Y. Sudah
- Department of Orthopedic Surgery, Monmouth Medical Center, Long Branch Chicago, Illinois, U.S.A
| | - Joseph E. Manzi
- Department of Orthopaedic Surgery, Lenox Hill Hospital, New York, New York U.S.A
| | - Christopher R. Michel
- Department of Orthopedic Surgery, Monmouth Medical Center, Long Branch Chicago, Illinois, U.S.A
| | - Dane M. Pizzo
- Robert Wood Johnson Medical School, New Brunswick Chicago, Illinois, U.S.A
| | - Mariano E. Menendez
- Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois, U.S.A
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Russo SA, Topley MT, Richardson RT, Richards JG, Chafetz RS, Rapp van Roden EA, Zlotolow DA, Mulcahey MJ, Kozin SH. Assessment of the relationship between Brachial Plexus Profile activity short form scores and modified Mallet scores. J Hand Ther 2022; 35:51-57. [PMID: 33308927 DOI: 10.1016/j.jht.2020.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Revised: 09/19/2020] [Accepted: 10/09/2020] [Indexed: 02/03/2023]
Abstract
INTRODUCTION This study aims to assess the relationship between the modified Mallet classification and the Brachial Plexus Profile activity short form (BP-PRO activity SF). The therapist or surgeon classifies upper extremity movement for the modified Mallet classification, while the BP-PRO assesses parents' perceptions of difficulty performing activities. PURPOSE To provide a deeper understanding of the relationship of functional and perceived outcome measurements. STUDY DESIGN Prospective, correlational design. METHODS Eighty children with brachial plexus birth injuries were evaluated using the modified Mallet classification, while parents simultaneously answered the BP-PRO activity SF questions. All patients had undergone one of three surgical interventions to improve shoulder function. The relationship between the two measures, patient injury levels, and surgical histories were assessed. RESULTS The average modified Mallet scores and BP-PRO activity SF scores weakly correlated (r = 0.312, P = .005) and both measures differentiated between C5-6 and C5-7 injury levels (P = .03 and P = .02, respectively). Conversely, the modified Mallet scores could differentiate between the three surgical groups (F = 8.2, P < .001), while the BP-PRO activity SF could not (P = .54). CONCLUSION The results suggest that these tools measure different aspects of patient outcomes. The Mallet classification may be more focused on shoulder motion than the BP-PRO activity SF. Additional questions that specifically require shoulder function could be incorporated into the BP-PRO activity SF to improve understanding of patient/parent perceptions of shoulder function for children with brachial plexus injuries. Clinicians should be aware of the strengths, weaknesses, and limitations of each outcome assessment tool for appropriate use and interpretation of results.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Scott H Kozin
- Shriners Hospital for Children, Philadelphia, PA, USA
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Surgical Soft Tissue Management for Glenohumeral Deformity and Contractures in Brachial Plexus Birth Injury : A Systematic Review and Meta-analysis. Curr Rev Musculoskelet Med 2022; 15:107-120. [PMID: 35156170 DOI: 10.1007/s12178-022-09747-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/29/2021] [Indexed: 10/19/2022]
Abstract
PURPOSE OF THE REVIEW Consensus on the effects of soft tissue surgical intervention in the management of brachial plexus birth injury (BPBI) sequalae is lacking. The purpose of this review is to examine the available literature on the functional and structural outcomes following soft tissue surgical management of BPBI sequalae. RECENT FINDINGS EMBASE, PubMed, and MEDLINE were searched for related literature from the point of database inception until April 2021. Relevant papers were screened by two reviewers independently and in duplicate. A meta-analysis was performed using a random effects model. A total of 25 studies (852 patients) were included in the review, with the number included in each meta-analysis varying based on outcome of interest. There were significant improvements from pre- to post-operative time points for the following measures: Mallet aggregate scores (5.0 points, p<0.0001), active external rotation in adduction (48.9°, p=0.003), passive external rotation in adduction (64.6°, p< 0.00001), active abduction (46.2°, p<0.00001), glenoid version (14.4°, p< 0.00001), and percentage of the humeral head anterior to the scapular line (17.53°, p< 0.00001). Furthermore, data revealed an overall complication rate of 9.3% (79/852 patients) and a major complication rate of 0.47% (4/852 patients). Patients with BPBI sequela experience statistically significant improvements in functional, structural, and range of motion outcomes of the GH joint following soft tissue surgical management. Understanding the ideal indications for each procedure and age of surgical management with future prospective studies will help to optimize surgical management of these patients.
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Massamba Vuvu T, Dorniol M, Le Nen D, Thépaut M, Brochard S, Pons C. Effect of arthroscopic shoulder release on shoulder mobility and bone deformity following brachial plexus birth injury: a systematic review and meta-analysis. J Shoulder Elbow Surg 2021; 30:2428-2437. [PMID: 33567353 DOI: 10.1016/j.jse.2020.12.021] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 12/20/2020] [Accepted: 12/27/2020] [Indexed: 02/01/2023]
Abstract
BACKGROUND Specific information to guide clinical practice is lacking for the effects of arthroscopic release on bone and joint deformities, as well as the additional benefits of tendon transfer, in children with brachial plexus birth injury. The aims of this study were (1) to evaluate changes in shoulder mobility and bone and joint deformity, (2) to evaluate the effect of release with and without tendon transfer on the same outcomes, and (3) to evaluate the perioperative and long-term complications. METHODS We conducted a systematic review and meta-analysis. Four databases were searched using relevant inclusion and exclusion criteria from inception until May 2020. The quality of articles was evaluated using the Methodological Index for Non-randomized Studies (MINORS) scale. Data regarding patients, interventions, and clinical and radiologic outcomes were reported. RESULTS Thirteen articles were included: 6 of low quality and 7 of moderate quality separated into 17 studies (266 children). The mean follow-up duration was 32.4 months (standard deviation, 15.2 months). Arthroscopic release significantly improved the Mallet score (standardized mean difference [SMD], 3.1 [95% confidence interval (CI), 1.5-4.7]; P < .001) and passive external rotation (SMD, 3.6 [95% CI, 2.3-4.9]; P = .02). The percentage of humeral head anterior (SMD, 1.3 [95% CI, 0.7-1.9]; P = .003) and glenoid retroversion (SMD, 1.4 [95% CI, 0.9-2]; P = .01) also improved. Descriptive analysis of the data suggested that concomitant tendon transfer further improved mobility. Recurrence of internal-rotation contracture was reported in 8 of 157 children. DISCUSSION This systematic review showed that arthroscopic release effectively improves both shoulder mobility and bone deformity, with few complications in young children with brachial plexus birth injury. As such, it seems reasonable to propose a stepwise approach starting with a release without transfer.
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Affiliation(s)
- Tatiana Massamba Vuvu
- Hand Surgery Unit, Orthopaedic Surgery Department, Centre Hospitalier Régional Universitaire (CHRU) La Cavale Blanche, Brest, France; Paediatric Surgery Department, Centre Hospitalier Régional Universitaire (CHRU) Morvan, Brest, France; Université de Bretagne Occidentale, Brest, France.
| | - Morgane Dorniol
- Hand Surgery Unit, Orthopaedic Surgery Department, Centre Hospitalier Régional Universitaire (CHRU) La Cavale Blanche, Brest, France; Université de Bretagne Occidentale, Brest, France
| | - Dominique Le Nen
- Hand Surgery Unit, Orthopaedic Surgery Department, Centre Hospitalier Régional Universitaire (CHRU) La Cavale Blanche, Brest, France; Université de Bretagne Occidentale, Brest, France
| | - Matthias Thépaut
- Paediatric Surgery Department, Centre Hospitalier Régional Universitaire (CHRU) Morvan, Brest, France; Université de Bretagne Occidentale, Brest, France
| | - Sylvain Brochard
- Physical Medicine and Rehabilitation Department, Centre Hospitalier Régional Universitaire (CHRU) Brest, Brest, France; Laboratoire de Traitement de l'Information Médicale, Inserm U1101, Université de Bretagne Occidentale, Brest, France; Pediatric Rehabilitation Department, Fondation Ildys, Brest, France
| | - Christelle Pons
- Physical Medicine and Rehabilitation Department, Centre Hospitalier Régional Universitaire (CHRU) Brest, Brest, France; Laboratoire de Traitement de l'Information Médicale, Inserm U1101, Université de Bretagne Occidentale, Brest, France; Pediatric Rehabilitation Department, Fondation Ildys, Brest, France
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Allard R, Fitoussi F, Azarpira MR, Bachy M, Grimberg J, Le Hanneur M. Shoulder internal rotation contracture in brachial plexus birth injury: proximal or distal subscapularis release? J Shoulder Elbow Surg 2021; 30:1117-1127. [PMID: 32853791 DOI: 10.1016/j.jse.2020.08.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 07/23/2020] [Accepted: 08/02/2020] [Indexed: 02/01/2023]
Abstract
BACKGROUND In cases of brachial plexus birth injury with internal rotation contracture of the shoulder, the subscapularis muscle may be released proximally, from the subscapular fossa, or distally, along with periarticular soft tissues arthroscopic to the glenohumeral joint. We hypothesized that the indication for each procedure would rely primarily on patients' bone remodeling potential and periarticular soft-tissue contractures, performing proximal releases in patients aged < 4 years and periarticular distal releases in older patients. The purpose of this study was to analyze the outcomes such a strategy could provide. METHODS All patients presenting with brachial plexus birth injury-related shoulder internal rotation contractures who underwent a subscapularis release were included; in addition, to restore the joint axial balance, the infraspinatus was systematically reanimated with a tendon transfer (ie, latissimus dorsi or lower trapezius) during the same operating time. Chart review yielded preoperative and postoperative clinical and radiographic measurements, including active and passive range of motion of the shoulder in external rotation (ER) with the arm at the side of the body, the modified Mallet score, glenoid version, and the percentage of the humeral head arthroscopic to the middle of the glenoid process. RESULTS Between July 2012 and January 2018, 28 children were operated on at our institution. In patients who underwent proximal subscapularis release (n = 13), significant improvements were observed regarding active shoulder ER, passive shoulder ER, the modified Mallet score, glenoid version, and the percentage of the humeral head arthroscopic to the middle of the glenoid process, averaging 58° ± 32° (P < .0001), 56° ± 20° (P < .0001), 9.7 ± 3.1 points (P = .0006), 15° ± 10° (P = .0034), and 24% ± 20% (P = .0113), respectively, after a mean follow-up period of 4 years. Following distal release procedures (n = 15), these improvements averaged 26° ± 29° (P = .0024), 27° ± 28° (P = .0011), 3.3 ± 4.1 points (P = .0049), 2° ± 17° (P = .4086), and 4% ± 18% (P = .215), respectively, after a mean follow-up period of 3 years. CONCLUSION When combined with axial rebalancing of the joint, the proximal release of the subscapularis muscle appears to be sufficient to provide satisfactory functional outcomes in patients with great bone remodeling potential and supple periarticular soft tissues. In older patients, a more comprehensive release of the glenohumeral joint's arthroscopic aspect seems to provide lower but still significant clinical improvements.
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Affiliation(s)
- Romain Allard
- Department of Pediatric Orthopedics, Armand Trousseau Hospital-Sorbonne University, Paris, France
| | - Franck Fitoussi
- Department of Pediatric Orthopedics, Armand Trousseau Hospital-Sorbonne University, Paris, France
| | - Mohammad Reza Azarpira
- Department of Pediatric Orthopedics, Armand Trousseau Hospital-Sorbonne University, Paris, France
| | - Manon Bachy
- Department of Pediatric Orthopedics, Armand Trousseau Hospital-Sorbonne University, Paris, France
| | - Jean Grimberg
- Department of Pediatric Orthopedics, Armand Trousseau Hospital-Sorbonne University, Paris, France; Department of Orthopedic Surgery, Clinique Jouvenet-Ramsay-Générale de Santé, Paris, France; Institute of Research in Orthopedics and Sports Surgery (IRCOS), Paris, France
| | - Malo Le Hanneur
- Department of Pediatric Orthopedics, Armand Trousseau Hospital-Sorbonne University, Paris, France.
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Russo SA, Zlotolow DA, Chafetz RS, Rodriguez LM, Kelly D, Linamen H, Richards JG, Lubahn JD, Kozin SH. Efficacy of 3 therapeutic taping configurations for children with brachial plexus birth palsy. J Hand Ther 2019; 31:357-370. [PMID: 28454773 DOI: 10.1016/j.jht.2017.03.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2016] [Revised: 12/10/2016] [Accepted: 03/20/2017] [Indexed: 02/09/2023]
Abstract
STUDY DESIGN Cross-sectional clinical measurement study. INTRODUCTION Scapular winging is a frequent complaint among children with brachial plexus birth palsy (BPBP). Therapeutic taping for scapular stabilization has been reported to decrease scapular winging. PURPOSE OF THE STUDY This study aimed to determine which therapeutic taping construct was most effective for children with BPBP. METHODS Twenty-eight children with BPBP participated in motion capture assessment with 4 taping conditions: (1) no tape, (2) facilitation of rhomboid major and rhomboid minor, (3) facilitation of middle and lower trapezius, and (4) facilitation of rhomboid major, rhomboid minor, and middle and lower trapezius (combination of both 2 and 3, referred to as combined taping). The participants held their arms in 4 positions: (1) neutral with arms by their sides, (2) hand to mouth, (3) hand to belly, and (4) maximum crossbody adduction (CBA). The scapulothoracic, glenohumeral and humerothoracic (HT) joint angles and joint angular displacements were compared using multivariate analyses of variance with Bonferroni corrections. RESULTS Scapular winging was significantly decreased in both the trapezius and combined taping conditions in all positions compared with no tape. Rhomboids taping had no effect. Combined taping reduced HT CBA in the CBA position. CONCLUSIONS Rhomboid taping cannot be recommended for treatment of children with BPBP. Both trapezius and combined taping approaches reduced scapular winging, but HT CBA was limited with combined taping. Therefore, therapeutic taping of middle and lower trapezius was the most effective configuration for scapular stabilization in children with BPBP. Resting posture improved, but performance of the positions was not significantly improved. LEVEL OF EVIDENCE Level II.
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Affiliation(s)
- Stephanie A Russo
- Department of Orthopedic Surgery, University of Pittsburgh Medical Center - Hamot, Erie, PA, USA.
| | - Dan A Zlotolow
- Upper Extremity Center of Excellence, Shriners Hospital for Children, Philadelphia, PA, USA
| | - Ross S Chafetz
- Upper Extremity Center of Excellence, Shriners Hospital for Children, Philadelphia, PA, USA
| | - Luisa M Rodriguez
- Upper Extremity Center of Excellence, Shriners Hospital for Children, Philadelphia, PA, USA
| | - Devin Kelly
- Movement Analysis Laboratory, Shriners Hospital for Children, Erie, PA, USA
| | - Holly Linamen
- Department of Physical and Occupational Therapy, Shriners Hospital for Children, Erie, PA, USA
| | - James G Richards
- Department of Kinesiology and Applied Physiology, University of Delaware, Newark, DE, USA
| | - John D Lubahn
- Department of Orthopedic Surgery, University of Pittsburgh Medical Center - Hamot, Erie, PA, USA
| | - Scott H Kozin
- Upper Extremity Center of Excellence, Shriners Hospital for Children, Philadelphia, PA, USA
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Burnier M, Le Hanneur M, Cambon-Binder A, Belkheyar Z. Isolated open anterior shoulder release in brachial plexus birth palsy. J Shoulder Elbow Surg 2019; 28:1347-1355. [PMID: 30981548 DOI: 10.1016/j.jse.2018.12.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Revised: 12/18/2018] [Accepted: 12/20/2018] [Indexed: 02/01/2023]
Abstract
BACKGROUND In children with brachial plexus birth palsy (BPBP), a shoulder joint internal contracture is commonly observed, which may result in glenohumeral osseous deformities and posterior joint subluxation. The purpose of this retrospective study was to evaluate the impact of an isolated anterior shoulder release on osteoarticular disorders and assess the subsequent clinical improvements. METHODS Forty consecutive BPBP patients with glenohumeral dysplasia underwent an open anterior shoulder release. Shoulder scans (ie, magnetic resonance imaging preoperatively and computed tomography postoperatively) were conducted to assess glenoid version and the percentage of the humeral head anterior to the middle of the glenoid fossa. Clinical data including analytical shoulder range of motion and modified Mallet scores were collected. RESULTS After a mean follow-up period of 23 months, glenoid version and the percentage of the humeral head anterior to the middle of the glenoid fossa significantly improved from -32° and 18%, respectively, to mean postoperative values of -12° (P < .001) and 45% (P < .001), respectively. Passive and active external rotation increased from -2° and -43°, respectively, to 76° (P < .001) and 54° (P < .001), respectively. The mean modified Mallet score significantly improved from 14.2 to 21.4 points (P < .001). In 8 children with satisfactory passive motion, a latissimus dorsi transfer was performed secondarily to obtain satisfactory active motion. CONCLUSION In BPBP patients with glenohumeral deformities, isolated open anterior release of the shoulder induces significant remodeling of the joint, reducing posterior joint subluxation and improving both passive and active shoulder ranges of motion. Additional latissimus transfer remains mandatory in selected cases to achieve satisfactory function.
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Affiliation(s)
- Marion Burnier
- Department of Hand and Upper Limb Surgery, Hôpital Edouard Herriot, Lyon, France; Department of Orthopedics, Service of Hand Surgery, Clinique du Mont Louis, Paris, France.
| | - Malo Le Hanneur
- Department of Orthopedics and Traumatology, Service of Hand, Upper Limb and Peripheral Nerve Surgery, Georges Pompidou European Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Adeline Cambon-Binder
- Department of Orthopedics and Traumatology, Service of Hand Surgery, Saint Antoine Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Zoubir Belkheyar
- Department of Orthopedics, Service of Hand Surgery, Clinique du Mont Louis, Paris, France
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Abstract
Shoulder stiffness affects a diverse population of patients suffering a decrease in function and shoulder pain. Arthroscopic management of this debilitating spectrum of pathology is a safe and effective course of action in cases recalcitrant to nonoperative therapy. Arthroscopic management of the stiff shoulder has been reported to be effective in the treatment of stiffness due to adhesive capsulitis, birth palsy, stiffness in the setting of rotator cuff tears, and osteoarthritis in the posttraumatic patient, in the postoperative patient, and in the throwing athlete. Arthroscopic management is most effective in treating the stiff shoulder in the setting of adhesive capsulitis recalcitrant to nonoperative therapy or posttraumatic stiffness. Results are more guarded in the treatment of postoperative stiffness. Excessive force and trauma to the shoulder, including fracture of the humerus, can be avoided with a 360[degrees] capsular release for shoulder stiffness rather than manipulation under anesthesia.
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Affiliation(s)
- Vasili Karas
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina
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Ruyer J, Grosclaude S, Lacroix P, Jardel S, Gazarian A. Arthroscopic isolated capsular release for shoulder contracture after brachial plexus birth palsy: clinical outcomes in a prospective cohort of 28 children with 2 years' follow-up. J Shoulder Elbow Surg 2018; 27:e243-e251. [PMID: 29609998 DOI: 10.1016/j.jse.2018.01.022] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2017] [Revised: 01/14/2018] [Accepted: 01/22/2018] [Indexed: 02/01/2023]
Abstract
BACKGROUND The primary objective of this study was to evaluate improvements in external rotation after isolated arthroscopic capsular release in children with shoulder contracture due to brachial plexus birth palsy. MATERIALS AND METHODS This study included all children older than 2 years with a range of active external rotation limited to 30° or less and/or active anterior elevation (AE) limited to 90° or less secondary to brachial plexus palsy treated between 2011 and 2015. Passive glenohumeral motion, passive global (glenohumeral plus scapulothoracic) motion, active global motion for external rotation with the elbow at the side (ER1), AE, and internal rotation with the elbow at the side were recorded before and 2 years after surgery. Improvement was evaluated by comparing the preoperative and follow-up values. The operation performed was subscapularis-sparing arthroscopic capsular release. RESULTS Thirty-five patients were included, and 28 completed 2 years of follow-up. The average changes in active global ER1, passive glenohumeral ER1, and passive global ER1 were +35° (range, -20° to +100°; P <.0001), +35° (range, +0° to +75°; P <.0001), and +26° (range, -15° to +60°; P <.0001), respectively. There were no significant changes in internal rotation with the elbow at the side or AE. The mean improvement in the aggregate Mallet score was 3.9 points (range, -3 to +9 points; P <.0001). CONCLUSIONS For children with shoulder contracture secondary to brachial plexus palsy, subscapularis-sparing isolated capsular release improves external rotation and functional scores and avoids any loss of active internal rotation but does not improve AE.
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Affiliation(s)
- Justin Ruyer
- Université Claude Bernard Lyon 1, Villeurbanne, France; Chirurgie Orthopédique et Traumatologie, Clinique du Parc Lyon, Lyon, France
| | - Sophie Grosclaude
- Chirurgie Orthopédique et Traumatologie, Clinique du Parc Lyon, Lyon, France
| | - Philippe Lacroix
- Médecine et Traumatologie du Sport, Clinique du Parc Lyon, Lyon, France
| | - Sabine Jardel
- Service de Médecine Interne et Pathologies Vasculaires, Centre Hospitalier Lyon-Sud, Hospices Civils de Lyon, Pierre-Bénite, France
| | - Aram Gazarian
- Chirurgie Orthopédique et Traumatologie, Clinique du Parc Lyon, Lyon, France; Orthopédie et Traumatologie Pédiatrique, Hôpital Femme-Mère-Enfant, Hospices Civils de Lyon, Bron, France.
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Remodeling after arthroscopic reduction of glenohumeral joint in adduction internal rotation shoulder deformity in obstetric brachial plexus palsy. CURRENT ORTHOPAEDIC PRACTICE 2017. [DOI: 10.1097/bco.0000000000000523] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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12
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Arthroscopic treatment for internal contracture of the shoulder secondary to brachial plexus birth palsy: report of a case series and review of the literature. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2015; 25:1121-9. [DOI: 10.1007/s00590-015-1670-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/23/2015] [Accepted: 06/29/2015] [Indexed: 10/23/2022]
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