Posterior subluxation and dislocation of the shoulder in obstetric brachial plexus palsy

Area of Science:

• Orthopedic Surgery
• Pediatric Neurology
• Rehabilitation Medicine

Background:

• Obstetric brachial plexus palsy (OBPP) frequently causes shoulder subluxation or dislocation.
• Shoulder deformity in OBPP can significantly impair upper limb function and quality of life.
• Early surgical intervention is often considered for managing these complications.

Purpose of the Study:

• To evaluate the surgical treatment outcomes for shoulder subluxation and dislocation in children with OBPP.
• To assess the impact of surgery on functional scores and range of motion.
• To identify factors influencing surgical success.

Main Methods:

• Prospective study of 183 consecutive cases (101 subluxation, 82 dislocation) of shoulder deformity secondary to OBPP.
• Surgical treatment performed between 1995 and 2000, with a mean follow-up of 40 months.
• Functional assessment using Mallet and Gilbert scores, and measurement of shoulder range of motion.

Main Results:

• Good or useful neurological recovery was observed in all patients with Narakas classification groups 1, 2, or 3.
• Significant improvements in Mallet (mean gain 3.6 levels) and Gilbert (mean gain 2.0) scores.
• Mean increase in active global shoulder movement (73°), active lateral rotation (58°), and forearm supination (51°). Active medial rotation decreased by 10°.
• 20 cases (10.9%) were considered failures.

Conclusions:

• Surgical treatment can effectively improve shoulder function and range of motion in children with OBPP-related shoulder deformities.
• Functional outcomes are correlated with the severity of the neurological deficit, duration of shoulder dislocation, and timing of deformity onset.
• Further research into optimizing surgical timing and techniques is warranted to minimize failure rates.