Deltoid contracture: a radiographic survey of bone and joint abnormalities

We performed a radiographic survey on 12 shoulders in 11 patients with a contracture of the deltoid present since childhood (juvenile) but left untreated until adulthood and on 14 shoulders in 10 patients with the same disorder first developed in adulthood (adult type). The greater tuberosity was located either under or near the acromion in all but 1 shoulder. Flattening of the humeral head, a high-positioned greater tuberosity, posterior rotation and vertical disposition of the acromion, inferior angulation of the lateral clavicle, and anterosuperior subluxation of the humeral head were noted in 58%, 33%, 75%, 67%, and 8% of the juvenile cases, respectively. Scoliosis and narrowing of the thoracic cage were each detected in 36% of the patients with juvenile deltoid contracture. Six of the juvenile cases were treated surgically and followed-up for a lengthy period. In these cases, however, the abnormalities persisted, except for subluxation of the humeral head and abnormal proximity of the acromion and greater tuberosity. In the adult-type cases no abnormalities were observed except for scoliosis in 4 patients and anterosuperior subluxation of the humeral head in 1 shoulder. We conclude that treatment by surgical intervention should be performed at an age when spontaneous correction of the bone deformity can prevent future development of secondary arthrosis.