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Tenomyoplastic procedures to improve shoulder function in the treatment of perinatal brachial plexus palsy
Jerzy Gosk1, Roman Rutowski, Piotr Mazurek
1Hospital Department of Traumatology, University Department of Traumatology and Hand Surgery, Wroclaw Medical University, Poland. chiruraz@churaz.am.wroc.pl
Insights
Tenomyoplastic procedures, including subscapular release and muscle transfers, significantly improve shoulder function in children with perinatal brachial plexus palsy, offering functional gains with low complication risks.
Area of Science:
- Pediatric Orthopedics
- Neuromuscular Surgery
- Rehabilitative Medicine
Background:
- Perinatal brachial plexus palsy often leads to shoulder contractures, severely impacting upper limb function.
- Surgical intervention is explored to address functional deficits caused by these contractures.
Purpose of the Study:
- To present surgical experience in improving shoulder joint function in perinatal brachial plexus palsy.
- To evaluate the outcomes of tenomyoplastic procedures for shoulder impairment.
Main Methods:
- 36 patients underwent 37 tenomyoplastic procedures.
- Procedures included subscapular release, teres major transfer, and trapezius transfer.
- Shoulder function was assessed using the Gilbert scale pre- and post-operatively.
Main Results:
- Subscapular release improved shoulder function in all patients (typically 1 Gilbert scale degree).
- Teres major transfer enhanced function in 4 patients with severe palsy (grades IV-V).
- One patient showed benefit from trapezius tenomyoplasty.
Conclusions:
- Tenomyoplasty is indicated for shoulder dysfunction in perinatal brachial plexus palsy, even after prior microsurgery or successful rehabilitation.
- Most patients experienced improvement, validating the advisability of these procedures.
- Functional improvement of the upper limb is achievable with minimal risk.
Background:
A contracture of the shoulder joint in the course of perinatal brachial plexus palsy significantly affects the function of the upper limb as a whole. The aim of this paper is to present the authors' experience in surgical procedures carried out to improve shoulder joint function impaired as a result of perinatal brachial plexus palsy and evaluate the treatment outcomes.
Material And Methods:
The study involved 36 patients who underwent 37 tenomyoplastic procedures (subscapular release, teres major transfer, transfer of a portion of the trapezius). Pre- and postoperative shoulder joint function was assessed with the Gilbert scale.
Results:
Surgical release of the subscapular muscle improved shoulder function in all patients, usually by 1 degree in the Gilbert scale. Teres major transfer improved shoulder function in all 4 patients (grade IV - 3 children, grade V - 1 child). One patient benefited from tenomyoplasty involving the trapezius.
Conclusions:
1. Indications for tenomyoplasty procedures in the region of the shoulder joint may be present both in children who had previously undergone microsurgery and in those in whom rehabilitation had led to a good outcome of perinatal brachial plexus palsy. 2. The fact that most patients improved following tenomyoplastic procedures justifies their advisability. A visible functional improvement of the upper limb can be achieved with a relatively low risk of complications.
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