Article
Does intra-articular and extra-articular soft tissue procedures can improve global shoulder function and glenohumeral deformity in OBPP patients? Retrospective cohort of 17 patients
Search Medline for
Authors
-
Alvaro Cho
- Instituto de Ortopedia e Traumatologia da FMUSP, Grupo de Mão e Microcirurgia da FMABC, Sao Paulo, Brazil
-
Marco Moraes
- Instituto de Ortopedia e Traumatologia da FMUSP, Sao Paulo, Brazil
-
Gustavo Bersani
- Instituto de Ortopedia e Traumatologia da FMUSP, Sao Paulo, Brazil
-
Raquel Iamaguchi
- Instituto de Ortopedia e Traumatologia da FMUSP, Sao Paulo, Brazil
-
Laura Lorimier
- Instituto de Ortopedia e Traumatologia da FMUSP, Sao Paulo, Brazil
-
Lendro Kiyohara
- Instituto de Ortopedia e Traumatologia da FMUSP, Grupo de Mão e Microcirurgia da FMABC, Sao Paulo, Brazil
-
Rames Mattar Júnior
- Instituto de Ortopedia e Traumatologia da FMUSP, Sao Paulo, Brazil
-
Marcelo Rezende
- Instituto de Ortopedia e Traumatologia da FMUSP, Sao Paulo, Brazil
-
Teng Wei
- Instituto de Ortopedia e Traumatologia da FMUSP, Sao Paulo, Brazil
| Published: | February 6, 2020 |
|---|
Outline
Text
Objectives/Interrogation: Whether or not combined intra-articular and extra-articular soft tissue procedures can improve global shoulder function and glenohumeral deformity in OBPP patients.
Methods: From March 2013 to October 2018, 30 procedures where performed in 27 children with obstetric brachial plexus palsy to improve shoulder shoulder external rotation and abduction. These procedures included combined latissimus dorsi and teres major transfer to the rotator cuff, musculotendinous lengthening of the pectoralis major and/or subscapularis tendons, open glenohumeral joint reduction and coracoidectomy in selected cases. Indication for surgery was progressive or stablished internal rotation contracture.
Inclusion criteria were children with minimum post-operative follow-up of 6 months, enough data to obtain pre and post-operative modified Mallet scores (including the internal rotation category) and imaging of the shoulder (CT and MRI) to access Waters' Classification. Ten patients did not meet the inclusion criteria due to insufficient follow -up or incomplete data. Therefore, 17 patients were included in this study.
Results and Conclusions: There were 6 boys and 11 girls with a mean age of 3,7 years, ranging from 1 to 10 years. The mean post operative follow-up was 29 months, ranging from 6 to 59 months.
According to the Waters Classification, we had 9 patients with type IV, 7 patients with type III and 1 patient with type II glenohumeral deformity.
The average pre-operative modified Mallet score was 15.92 (SD:1.94). The average post-operative modified Mallet score was 20.21 (SD:2.08). The average increase in modified Mallet score was 4.28 (SD:2.78). Post-operative imaging was performed in 10 patients, and 70% of those presented significant joint remodelling.
Although all patients but one showed improvement in global shoulder function, we found some loss of internal rotation in 57% of Waters type IV patients, and 12.5% of Waters type II or III patients (p=NS). The overall incidence of internal rotation loss, including all patients, was 33,33%.
Combined intra-articular and extra-articular soft tissue procedures can improve global shoulder function and glenohumeral congruency in OBPP. Some degree of internal rotation loss can be expected in approximately 1/3 of the patients as a side-effect of the subscapularis tendon lengthening.
