Shoulder Function Reconstruction in Brachial Plexus Birth Injury: Anterior Shoulder Release and Spinal Accessory to
Jayme A Bertelli1, Mohammed Tahir2
1Department of Plastic Surgery, Joana de Gusmão Children's Hospital, Florianópolis, Santa Catarina, Brazil; Department of Surgery, Federal University of Santa Catarina, Florianópolis, Brazil.
Insights
Spinal accessory to suprascapular nerve transfer with anterior shoulder release significantly improved shoulder external rotation and abduction in children with brachial plexus birth injury. This surgical intervention offers a promising solution for restoring shoulder function.
Area of Science:
- Orthopedic Surgery
- Pediatric Surgery
- Neurosurgery
Background:
- Brachial plexus birth injury (BPBI) often results in shoulder internal rotation contractures and limited abduction.
- Restoring shoulder function in BPBI patients is crucial for upper extremity use and overall quality of life.
Purpose of the Study:
- To evaluate the efficacy of spinal accessory to suprascapular nerve transfer combined with anterior shoulder release.
- To assess the restoration of shoulder external rotation and abduction in pediatric patients with BPBI.
Main Methods:
- A cohort of 41 children with BPBI underwent surgical intervention including anterior shoulder release and nerve transfer.
- Procedures involved subscapularis tenotomy, capsulotomy, and spinal accessory to suprascapular nerve transfer.
- Postoperative range of motion for abduction and external rotation was compared to preoperative status at an average of 31 months follow-up.
Main Results:
- 26 patients were analyzed, with an average age of 15 months at surgery.
- Significant improvements were observed: average external rotation increased from 64° to 116°, and abduction from 36° to 94°.
- Most patients showed functional improvement without recurrence of internal rotation contractures; one patient did not recover external rotation.
Conclusions:
- Spinal accessory to suprascapular nerve transfer, with subscapularis tenotomy, effectively improves shoulder external rotation and abduction in children with BPBI.
- The timing of the nerve transfer (before or after 6 months of age) did not impede significant functional gains.
- This surgical approach is a viable option for managing internal rotation contractures and improving shoulder mobility in pediatric BPBI.
Purpose:
This study evaluated the efficacy of the spinal accessory to suprascapular nerve transfer accompanied by anterior shoulder release in restoring shoulder external rotation and abduction in patients with brachial plexus birth injury.
Methods:
A cohort of 41 children with brachial plexus birth injury and shoulder internal rotation contractures underwent surgical intervention. The procedure involved an anterior shoulder release encompassing subscapularis tenotomy, capsulotomy and division of the coracohumeral ligament, and transfer of the spinal accessory nerve to the suprascapular nerve. At an average of 31 months after surgery, we conducted postoperative evaluations of shoulder abduction and external rotation range of motion and compared those with the preoperative status of the patients.
Results:
From the initial cohort, 26 patients with sufficient follow-up were included in the analysis. The average age at surgery was 15 months. Before surgery, patients demonstrated an average active abduction of 36° and an internal rotation contracture of 64°, measured with the elbow flexed, the shoulder adducted, and using the thorax as the 0° reference point. After surgery, there were significant improvements, with average external rotation increasing to 116° and abduction to 94°. One patient failed to recover external rotation, but most patients showed improved function without the recurrence of internal rotation contractures.
Conclusions:
Spinal accessory to suprascapular nerve transfer before or after 6 months of age combined with subscapularis tenotomy significantly improves shoulder external rotation and abduction in children with brachial plexus birth injury and internal rotation contractures.
Type Of Study/Level Of Evidence:
Therapeutic IV.
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