Effectiveness of modified Hoffer transfer and subscapularis release on glenohumeral joint remodeling in brachial plexus birth palsy children with moderate-severe glenohumeral deformities: a case series study

Background

Treatment of brachial plexus birth injury sequelae is historically based on glenohumeral joint deformity as described by Waters. Patients with advanced deformities usually treated with bony procedures based on the unknown remodeling potentials following soft tissue rebalance. We aim to assess the clinical and radiological outcomes following soft tissue rebalance of this group.

Methods

Eight patients (age: 3-6.3 years) with advanced stages (Waters type 3-5) residual Erb’s palsy were retrospectively included. They were treated by modified Hoffer transfer and subscapularis release procedure and followed up for 13-49 months. Assessment tools were clinical and radiological.

Results

There were statistically significant improvements of all assessed parameters. The mean aggregated modified Mallet score improved from 19.38 preoperatively to 27.88 at the end of follow-up. Radiologically, the mean glenoid retroversion improved from −17.87° preoperatively to −6.12° at the end. Similarly, the percent humeral head anterior to glenoid fossa improved from mean 22.18% to 38.12%. All these changes are reflected on glenohumeral deformity stage (Waters classification) with improvements of all patients by 2 grades apart from 2 who improved by 1.

Conclusion

Moderate-severe shoulder deformity secondary to brachial plexus birth injury sequelae can be effectively treated by soft tissue rebalance and it could alter the natural history of the disease.