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Updated: Jun 1, 2026
Development of a Neonatal Rat Model for Brachial Plexus Birth Injury
Published on: March 27, 2026
Treatment of shoulder sequelae in brachial plexus birth injury
Tiina Pöyhiä1, Antti Lamminen, Jari Peltonen
1Department of Surgery, Hospital for Children and Adolescents, Helsinki Medical Imaging Center, Helsinki University Central Hospital, Helsinki, Finland. tiina.poyhia@hus.fi
Insights
Surgical shoulder operations can improve range of motion and joint position in children with brachial plexus birth injury (BPBI). Relocation of the humeral head is particularly effective for joint remodeling and improving congruency.
Area of Science:
- Orthopedic Surgery
- Pediatric Orthopedics
- Pediatric Rehabilitation
Background:
- Children with permanent brachial plexus birth injury (BPBI) often develop shoulder problems and joint deformity without intervention.
- Surgical management aims to address these complications and improve functional outcomes.
Purpose of the Study:
- To assess the indications and outcomes of various shoulder operations for BPBI.
- To evaluate the effectiveness of surgical interventions in improving shoulder function and joint congruency.
Main Methods:
- A retrospective study of 31 pediatric patients with BPBI who underwent shoulder surgery.
- Surgical procedures included humeral head relocation, external rotation osteotomy, subscapular tendon lengthening, and teres major transposition.
- Pre- and postoperative assessments included range of motion, Mallet scale function, MRI, glenohumeral joint congruency, glenoglenoscapular angle (GSA), and percentage of humeral head anterior (PHHA).
Main Results:
- 30 out of 31 patients reported satisfactory subjective outcomes.
- Humeral head relocation significantly improved shoulder joint congruency (10/13 patients), with mean improvements in GSA (33°) and PHHA (25%).
- Other surgical methods showed varied improvements in Mallet scores, but less impact on joint congruency.
Conclusions:
- Shoulder surgery can effectively improve range of motion and glenohumeral joint malposition in pediatric BPBI.
- Humeral head relocation promotes joint remodeling and improved congruency in young patients with BPBI.
Background:
Many children with permanent brachial plexus birth injury (BPBI) develop shoulder problems, with subsequent joint deformity without treatment. We assessed the indications and outcome of shoulder operations for BPBI.
Patients And Methods:
31 BPBI patients who had undergone a shoulder operation in our hospital between March 2002 and December 2005 were included in the study. Relocation of the humeral head had been performed in 13 patients, external rotation osteotomy of the humerus in 5 patients, subscapular tendon lengthening in 5 patients, and teres major transposition in 8 patients. Subjective results were registered. Shoulder range of motion was measured, and function assessed according to the Mallet scale. Magnetic resonance imaging (MRI) was performed pre- and postoperatively. Glenoscapular angle (GSA) and percentage of humeral head anterior to the middle of the glenoid fossa (PHHA) were measured. Congruency of the glenohumeral joint (GHJ) was estimated. The mean follow-up time was 3.8 (1.7-6.8) years.
Results:
At follow-up, the subjective result was satisfactory in 30 of the 31 patients. There were 4 failures, which in retrospect were due to wrong choice of surgical method in 3 of these 4 patients. Mean increase in Mallet score was 5.5 after successful relocation, 1.4 after rotation osteotomy, 2.2 after subscapular tendon lengthening, and 3.1 after teres major transposition. Congruency of the shoulder joint improved in 10 of 13 patients who had undergone a relocation operation, with mean improvement in GSA of 33º and mean increase in PHHA of 25%. There were no substantial changes in congruency of the glenohumeral joint in patients treated with other operation types.
Interpretation:
Restriction of the range of motion and malposition of the glenohumeral joint can be improved surgically in brachial plexus birth injury. Remodeling of the joint takes place after successful relocation of the humeral head in young patients.
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