Evaluation of shoulder function after secondary surgery in children with Neonatal Brachial Plexus Palsy

Area of Science:

• Pediatric Orthopedics
• Reconstructive Surgery
• Neurorehabilitation

Background:

• Neonatal Brachial Plexus Palsy (NBPP) often results in impaired shoulder function.
• Restoring external rotation is crucial for improving arm use and overall function.
• Surgical interventions like ICL+MTT aim to enhance shoulder capabilities in affected children.

Purpose of the Study:

• To evaluate the functional outcomes of internal contracture release and muscle tendon transfer (ICL+MTT) for external rotation in children with NBPP.
• To assess improvements in range of motion, muscle strength, and arm function post-intervention.
• To determine the impact on Quality of Life (QoL) and parental satisfaction.

Main Methods:

• A cohort of ten children (aged 3-10 years) with NBPP underwent combined ICL+MTT (Latissimus Dorsi/Teres Major).
• Pre-operative and 3, 6, 12-month post-operative assessments included joint mobility (ROM), muscle strength, arm function (AHA, Mallet-score), and QoL (PODCI).
• Statistical analysis used Wilcoxon's Signed-Rank test and Cohen's effect size to evaluate changes.

Main Results:

• Significant improvements were observed in active and passive external rotation ROM and muscle strength (p < 0.05).
• Arm function showed significant gains in Mallet-scores (Hand-to-Head, Hand-to-Mouth, External-Rotation) and AHA scales (arm use, pace) (p < 0.05).
• PODCI subscales for Upper Extremity/Physical Functioning and Global Functioning improved (p < 0.05), alongside high parental satisfaction.

Conclusions:

• ICL+MTT is an effective surgical intervention for improving shoulder range of motion, strength, and arm function in children with NBPP.
• The procedure positively impacts Quality of Life and leads to high levels of parental satisfaction.
• ICL+MTT should be considered for children with NBPP experiencing limited shoulder function.