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Three dimensionality of gleno-humeral deformities in obstetrical brachial plexus palsy

Sylvain Brochard1,2,3, Joseph D Mozingo1,4, Katharine E Alter1,5

  • 1Functional and Applied Biomechanics Section, Rehabilitation Medicine Department, National Institutes of Health, Bethesda, Maryland.

Journal of Orthopaedic Research : Official Publication of the Orthopaedic Research Society
|September 13, 2015
PubMed

Insights

This study confirms that gleno-humeral deformity in children with obstetrical brachial plexus palsy is three-dimensional (3D). Advanced 3D analysis is crucial for accurate follow-up and treatment planning in these patients.

Area of Science:

  • Orthopedics
  • Pediatric Medicine
  • Medical Imaging

Background:

  • Obstetrical brachial plexus palsy (OBPP) can lead to significant gleno-humeral deformity in affected children.
  • Traditional two-dimensional (2D) imaging may not fully capture the complex, three-dimensional (3D) nature of this deformity.
  • Accurate characterization of gleno-humeral morphology is essential for effective management.

Purpose of the Study:

  • To test the hypothesis that gleno-humeral deformity in children and adolescents with OBPP is three-dimensional (3D).
  • To compare the metrological properties of standard 2D gleno-humeral measures with newly developed 3D measures.
  • To evaluate the clinical utility of 3D imaging for assessing OBPP-related shoulder deformities.

Main Methods:

  • Acquisition of 3D axial magnetic resonance images (MRIs) of the shoulders in 13 children with OBPP.
  • Creation of 3D glenoid and humeral models to quantify 3D glenoid version, humeral head migration, and glenoid concavity.
  • Comparison of 3D measurements with standard 2D measures, with all assessments performed by two blinded observers.

Main Results:

  • The affected glenoid showed significant retroversion (7.91°) and inferior orientation (7.28°) compared to the non-involved side.
  • Humeral head migration was significantly posterior (5.54 mm), inferior (-3.96 mm), and medial (-3.63 mm) in the affected shoulders.
  • Eleven of 13 glenoids exhibited concavity based on 3D models, and 3D measures demonstrated higher precision than 2D measures for version.

Conclusions:

  • Gleno-humeral deformity in OBPP is unequivocally three-dimensional (3D).
  • 3D subject-specific gleno-humeral shape analysis is necessary for precise follow-up and treatment planning in children with OBPP.
  • 3D imaging offers superior accuracy and reliability for characterizing shoulder deformities in OBPP compared to traditional 2D methods.

Keywords:
brachial plexus palsyglenoid versionhumeral head migrationreliabilityshoulderthree dimensional imagingvalidation

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