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Secondary gleno-humeral joint dysplasia in children with persistent obstetric brachial plexus palsy
Marcin Sibinski1, Bartłomiej Woźniakowski, Marek Drobniewski
1Clinic of Orthopedic and Pediatric Orthopedics, Medical University of Lodz, Lodz, Poland. sibinek@poczta.onet.pl
Insights
Children with obstetric brachial plexus palsy often have glenohumeral joint deformation, impacting limb function. CT scans reveal joint instability and retroversion correlate with poorer shoulder function.
Area of Science:
- Orthopedics
- Pediatric Neurology
- Radiology
Background:
- Obstetric brachial plexus palsy (OBPP) can lead to persistent glenohumeral joint deformities in children.
- These deformities may significantly affect upper limb function and development.
Purpose of the Study:
- To evaluate the degree of glenohumeral joint deformation in children with OBPP.
- To assess the relationship between joint deformation and limb function in affected children.
Main Methods:
- Computed tomography (CT) scans were performed on 24 children (mean age 6.1 years) with OBPP.
- Measurements included glen-scapular angle, glenohumeral joint congruency, and Waters' criteria for joint deformity.
- Functional outcomes were assessed using the Mallet classification system.
Main Results:
- Significant differences in glen-scapular angle were observed between affected (23.3°) and non-affected (4.5°) sides.
- Glenoid retroversion was more pronounced in older children and correlated with limited passive external rotation and active internal rotation.
- Posterior subluxation or dislocation of the humeral head was present in 16 cases, with associated functional limitations.
- Humeral heads were deformed and smaller on the affected side in all cases.
Conclusions:
- Glenoid retroversion, posterior humeral head subluxation/dislocation, and smaller humeral head size are common CT findings in children with OBPP.
- Shoulder function, particularly passive external rotation, is closely linked to the severity of glenoid deformity and humeral head dislocation.
Abstract:
The study aimed to evaluate the degree of gleno-humeral joint deformation in children with persistent obstetric brachial plexus palsy and its effect on limb function. Computer tomography was performed in 24 children in the mean age of 6.1 years. There were eight boys and 16 girls. Gleno-scapular angle, congruency of gleno-humeral joint and joint deformity according to Waters at all. criteria were measured. The mean functional score according to the Mallet classification system was 12.3 points. The joint was stabile in nine, subluxed in seven and dislocated in nine cases. Gleno-scapular angle in affected joints was 23.3 degrees and in non-affected 4.5 degrees. The glenoid was statistically more retroverted in older children. With more severe posterior incongruence there was statistically greater limitation of passive external rotation, active internal rotation and a poorer functional result according to Mallet. Abnormalities were found also in the humeral head, being deformed and smaller compared to the non-affected side in all cases. Glenoid retroversion, posterior subluxation/dislocation of humeral head and smaller humeral head size are the abnormalities, most often identified in CT examinations. Shoulder function and in particular, passive, external rotation are closely associated with the degree of deformity of the glenoid, as well as with the extent of posterior humeral head dislocation.
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