Brachial plexus palsy secondary to birth injuries

Area of Science:

• Orthopedics
• Pediatric Surgery
• Neurology

Background:

• Obstetric brachial plexus palsy (OBPP) often results in significant functional deficits, including limited external rotation.
• Restoring active external rotation is crucial for shoulder function and quality of life in affected children.

Purpose of the Study:

• To assess the long-term efficacy of anterior shoulder release combined with posterior and lateral transfer of teres major and latissimus dorsi muscles for OBPP.
• To evaluate the durability of active external rotation achieved through this surgical intervention.

Main Methods:

• A cohort of ten patients with OBPP underwent anterior shoulder release and combined muscle transfer.
• Patients were followed for a mean of 30 years, with pre- and post-operative assessments of active external rotation and shoulder function.
• Radiological evaluation of the glenohumeral joint was performed.

Main Results:

• Initially, patients achieved a mean active external rotation of 36.5 degrees post-operatively.
• This improvement was maintained for approximately ten years.
• Long-term follow-up revealed a significant deterioration, with a mean active external rotation of only 10.5 degrees at the latest assessment.
• No improvement in active abduction was observed.

Conclusions:

• The surgical technique provides temporary improvement in active external rotation for obstetric brachial plexus palsy.
• Long-term results are compromised by factors such as muscle degeneration, soft tissue contracture, and glenohumeral joint changes.
• The early functional gains are not sustained, indicating limitations in the procedure's long-term effectiveness.