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Humeral Retroversion in Children with Shoulder Internal Rotation Contractures Secondary to Upper-Trunk Neonatal

Michael L Pearl1, Michael Batech, Fabian van de Bunt

  • 11Department of Orthopaedics, Kaiser Permanente, Los Angeles, California 2Division of Biostatistics, Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, California 3Department of Orthopaedics, Vrije Universiteit, Amsterdam, the Netherlands.

The Journal of Bone and Joint Surgery. American Volume
|December 8, 2016
PubMed

Insights

Neonatal brachial plexus palsy often causes internal rotation contractures, leading to decreased humeral retroversion in affected children. This finding is important for surgical planning to improve shoulder function.

Area of Science:

  • Pediatric Orthopedics
  • Pediatric Neurology
  • Biomedical Engineering

Background:

  • Neonatal brachial plexus palsy commonly results in shoulder internal rotation contractures, impacting function and causing glenohumeral joint deformation.
  • Surgical interventions aim to improve external rotation and function, but prior research on humeral retroversion in this condition shows conflicting results.
  • This study investigates humeral retroversion in children with internal rotation contractures due to neonatal brachial plexus palsy to inform surgical strategies.

Purpose of the Study:

  • To clarify the effect of neonatal brachial plexus palsy-induced internal rotation contractures on humeral retroversion.
  • To assess correlations between humeral retroversion, patient age, and contracture severity.
  • To provide data relevant for surgical planning in affected children.

Main Methods:

  • Retrospective analysis of bilateral shoulder and elbow MRI scans from 21 children with neonatal brachial plexus palsy.
  • Measurement of humeral retroversion using two reference axes (skew axis and humeral center line) relative to the transepicondylar line.
  • Assessment of glenoid version and glenohumeral morphology, correlating geometric variables with patient age and contracture severity.

Main Results:

  • Humeral retroversion was significantly decreased on the affected side (6° vs. 19° using skew axis; -2° vs. 20° using humeral center line).
  • Patient age was inversely correlated with retroversion, with a decrease of 2.4° per year.
  • Humeral retroversion did not correlate with contracture severity, glenoid version, or glenoid morphology type.

Conclusions:

  • Children with internal rotation contractures from neonatal brachial plexus palsy exhibit reduced humeral retroversion on the affected side.
  • These findings underscore the importance of considering altered humeral retroversion in surgical planning for such cases.
  • Understanding humeral version is crucial for optimizing functional outcomes in pediatric brachial plexus palsy.
Abstract

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