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[Diagnosis and treatment of deltoid contracture in children]
Xueyang Tang1, Lijun Liu, Mingxing Pen
1Department of Pediatric Surgery, West China Hospital, Sichuan University, Chengdu Sichuan 610041, P R China.
Insights
Deltoid contracture in children, often caused by injections, presents with shoulder deformity. Early surgical release of fibrous bands leads to excellent functional recovery, despite high initial misdiagnosis rates.
Area of Science:
- Pediatric Orthopedics
- Musculoskeletal Disorders
- Surgical Pathology
Context:
- Deltoid contracture is a condition affecting children, characterized by specific physical deformities.
- Previous literature may not fully detail the etiology, presentation, and outcomes of this condition in pediatric populations.
Purpose:
- To enhance the recognition of deltoid contracture in children.
- To investigate the causes, pathomechanism, diagnosis, and treatment of pediatric deltoid contracture.
Summary:
- This study analyzed clinical data from 9 pediatric patients (ages 5-14) with deltoid contracture.
- Key features include shoulder abduction deformity, limited adduction, scapular winging, and a palpable fibrous band in the deltoid muscle, often following intramuscular injections.
- A high misdiagnosis rate (90%) was observed, with all patients undergoing surgical release of fibrous bands, resulting in excellent functional recovery.
Impact:
- Highlights the importance of recognizing deltoid contracture in children to avoid misdiagnosis.
- Demonstrates the effectiveness of early surgical intervention for achieving significant functional improvement in pediatric deltoid contracture.
- Provides valuable insights for clinicians managing shoulder deformities in pediatric patients.
Objective:
To reinforce the recognization of deltoid contracture in children and probe its causes, pathomechanism, diagnosis and treatments.
Methods:
The Clinical data were summarized and analysed, including etiological factors, clinical situations, examinations and treatments from 9 child patients with deltoid contracture from 1992 to 2004. The 9 child patients were followed up to evaluate therapeutic efficacy.
Results:
Nine child patients with deltoid contracture included 4 boys and 5 girls, who aged from 5 to 14 years. The main clinical features were presented as abductive deformity, limitation of adduction of the shoulder, winging of the scapula, and dimpling of the skin with a palpable fibrous hard band in deltoid muscle. Four cases had a history of intramuscular injections in deltoid and 1 case was accompanied with bilateral gluteul contracture. Among the 9 patients, 8 cases were misdiagnosed before correct diagnosis and treatment. The misdiagnosis rate was up to 90%. All the cases received the operative treatments to release fibrous bands and were followed up for 8 months to 12 years. Abductive deformity disappeared and functions of the shoulders recovered in all patients, except 1 patient who had a lightly winged scapula.
Conclusion:
Deltoid contracture may be caused by multiple factors, but its clinical features are conductive to correct diagnosis and excellent therapeutic efficacy can be acquired by operation early.
