A modified Sever-L'Episcopo procedure for restoration of shoulder joint function in Erb's palsy.

Abstract

The aim of this study was to analyse the clinical outcome of a modified Sever-L'Episcopo technique for release of contracted muscles and tendon transfer to restore function of the shoulder joint in patients with Erb's palsy. A case series was conducted from March 1988 to November 2009 for 19 patients. The average age at operation was 8.4years. A single incision via an anterior approach to the shoulder joint was used. Elongation of the pectoralis major and subscapularis was carried out. Excision of most of the coracoid process was performed. Latissimus dorsi and teres major muscles were transferred from their insertion on the anteromedial aspect to the lateral aspect of the humerus via passing posteriorly to the shaft of the humerus. Anterior capsulotomy was done as needed to get concentric reduction of the glenohumeral joint. According to the modified Mallet classification, there was improvement in glenohumeral joint movement, with a total score increase from 11.5 to 20.1. The improvements of abduction and external rotation were statistically significant with a p value of less than 0.005 through application of the paired t test, comparing preoperative with postoperative values. Our modified technique in tendon transfer in treatment of Erb's palsy has led to improvement in glenohumeral joint function. This procedure can be applied efficiently in patients up to 16years of age.