Midterm Outcomes of Shoulder Dislocations in Brachial Plexus Birth Injuries Treated With Injection Botulinum Toxin A

Area of Science:

• Pediatric Orthopedics
• Neuromuscular Disorders

Background:

• Infantile shoulder dislocation is a recognized condition diagnosed via ultrasound.
• Botulinum toxin A injections can be an adjunct therapy for internal rotation contractures in shoulder dislocations.

Purpose of the Study:

• To evaluate intermediate-term outcomes of shoulder dislocations treated with botulinum toxin A injections.
• To identify factors influencing the success of this treatment.

Main Methods:

• Eighty-six children with ultrasound-diagnosed shoulder dislocation received botulinum toxin A injections.
• Sixty-two children were followed for a mean of 36 months, assessing the Hospital for Sick Children Active Movement Scale (HSC-AMS) and range of motion.
• Injections targeted the subscapularis and pectoralis major muscles, followed by stretching and casting.

Main Results:

• 44% of children required no further surgery (Group A).
• 44% experienced recurrence of internal rotation contracture (Group B).
• 12% developed external rotation contracture (Group C), associated with C7 muscle involvement.

Conclusions:

• Botulinum toxin A is effective for shoulder dislocations with early C5-C6 muscle recruitment.
• Avoid this procedure in children with C7 muscle involvement due to the risk of external rotation contracture.