Arthroscopic release of shoulder internal rotation contracture in children with brachial plexus birth palsy

In children with brachial plexus birth palsy, the unopposed contraction of the shoulder internal rotators and adductors, secondary to weakness of the external rotators and abductors, leads to internal rotation contracture of the shoulder joint. Latissimus dorsi and/or teres major tendon transfers combined with open musculotendinous lengthening can improve shoulder function. Arthroscopic release of the anterior glenohumeral ligaments, capsule and upper intra-articular subscapularis tendon, with or without tendon transfer(s), can also be performed in young children to restore external rotation and abduction of the shoulder. Joint alignment, thus obtained, may provide improvement of glenohumeral joint morphology in the long term, although the extent of glenoid remodeling has not been well defined. The authors review and discuss the recent literature on arthroscopic release, with or without tendon transfers, for reduction of the glenohumeral joint subluxation and for restoration of external rotation. Both pathologies respond well to these procedures. According to the literature, arthroscopic release "alone" may be sufficient in children up to 3 years. This minimally invasive procedure restores function successfully, and leads to a centered glenohumeral joint and to glenoid remodeling. A successful arthroscopic release of the shoulder in a 2.5-year-old child is described.