THE EFFECT OF TENDON TRANSFERS AND GLENOHUMERAL REDUCTION IN CASES OF O.B.P.P. WITH INTERNAL ROTATION CONTRACTURE

Abstract

Background : Brachial plexus birth palsy (BPBP) occurs in 1.5 per 1,000 live births, resulting from traction to the brachial plexus during delivery. Surgical treatment of the secondary shoulder dysfunction following BPBP aims to accomplish three goals: restoration of passive motion by contracture release, realignment of dysplastic glenohumeral joint, and augmentation of muscle power in the weak domains of shoulder movement. Objectives : To study the importance of reduction of the glenohumeral joint with soft tissue release and tendon transfer in treatment of internal rotation contracure deformity of shoulder in cases of O.B.P.P. Patients and methods: This prospective study was done in Microsurgery Unit Orthopedic department, Sohag University Hospitals including all patients with brachial plexus birth palsy with internal rotation contracure of the shoulder with mild to moderate glenohumeral dysplasia. The patients included in this series had a diagnosis of brachial plexus birth palsy and glenohumeral dysplasia classified as type II, III, or IV on the Waters scale; had undergone joint reduction, soft-tissue rebalancing, and tendon transfers; and the average follow up was three years. Results: Mean glenoid version improved from -33° to -7° following muscle rebalancing and soft-tissue releases. The percentage of the humeral head anterior to the middle of the glenoid improved from 8% to 43%. The average duration of clinical and radiographic follow-up was thirty-six months; improvements in both shoulder motion and glenohumeral joint morphology were seen early and were maintained during the follow up period. Conclusion: Latissimus dorsi and teres major tendon transfers to rotator cuff, combined with appropriate extra-articular musculotendinous lengthenings and joint reduction, result in improved shoulder function and glenohumeral joint remodeling in the majority of patients with brachial plexus birth palsy with mild to moderate dysplasia.