gms | German Medical Science

Objectives/Interrogation: Muscle imbalance in a growing child can lead to bone and joint deformities. Obstetric palsy patients with incomplete recovery have glenohumeral joint problems because of imbalance between shoulder adductor and internal rotator(IR) muscles & abductor external rotatuar(ER) muscles.

Although shoulder internal rotation contracture preventing shoulder abduction and external rotation in the most common problem in obstetric palsy patients with partial recovery; shoulder internal rotation limitation or external rotational conctacture is a worse condition preventing hand to belly and back functions hence limiting daily activities.

Methods: Fourteen patients had operation to improve shoulder ER and Abduction 3-5 years ago. Although their Abd and ER degrees improved dramatically; two years after the operation they had internal rotation limitation despite vigorous physiotheraphy. 15 patients did not have neither nerve nor palliative any operation before and had IR limitations preoperatively. During operation, posterior incision above spine of the scapula was performed, supraspinatus, infraspinatus and teres minor muscles, and acromion bone were encountered. The intraoperative observationwas not only heavily scarred muscle fascias which needed relaxation but also shortenned external rotator muscles which needed release and lateralization with V-Y fashion so that passive shoulder internal rotation movements were possible.

At 3rd day postoperative rehabilitation program, active range of motion exercises were initiated. All cases were evaluated by using range of motion measurement and Mallet scale.

Results and Conclusions: Average age of the children was 6,3 years and The average followup period was 21 months. The preoperative values in terms of IR were 2º and postoperatively 20º. Degree of abduction was mean 136 before the surgery. After surgery, it decreased to 105º but with theraphy it catched up preoperative values. Degree of external rotation value was mean 85º preoperatively. After the treatment, the external rotation value was measured 66,2º. The mean Mallet score improved from 18 preoperatively to 20 postoperatively.

Although shoulder abduction, ER problems are far more common in obstetrical palsy patients, there a group of patients which had internal rotation limitations either occured spontaneously or surgically. Facing with the reality we operated on these patients to achieve better hand to midline and back functions.