Abstract
To evaluate the clinical and functional results of surgical treatment for fibrous long head of the triceps in children. Data were analyzed from 32 patients (38 shoulders) aged over 5 years of age from August 1995 to December 2004. The adduction contracture, elbow flexed angles when the scapula was held in the chest wall, and scapulo-humeral angles in radiographs were measured. Surgical release of the long head of the triceps was performed. There were 22 females and 10 males in this study. Bilateral shoulder involvement was found in six patients. Only the right shoulder was involved in 5 patients, and only the left in 21 patients. All 32 patients (38 shoulders) developed adduction contracture of the shoulder after repeated intramuscular injection of antibiotic(s) into the long head of the triceps. Thirty-four shoulders (29 patients) were classified as severe, and four shoulders (3 patients) were classified as moderate. In all, we attained excellent results in 36 shoulders (94.7%) and good results in two shoulders (5.3%). There have been no fair or poor results or complications so far. Generally, surgical treatment of adduction contracture of the shoulder has achieved good results, with improved shoulder function. Releasing the long head of the triceps is a simple and safe surgical technique.
Highlights
Fibrous change in muscles may be congenital or secondary to intramuscular injection or direct trauma [1,2,3,4,5,6,7]
Measurements were taken with a goniometer of the adduction contracture angle and range of motion (ROM) of the elbow with the scapula held at the chest wall (Fig. 2e), the radiographic scapulo-humeral angle, as well as the range of motion (Fig. 2f)
We documented the following: dimpling of the skin, range of motion, adduction contracture, elbow extension angles, elbow flexion angles with the scapula held at the chest wall, functional use of the upper extremity for grooming, radiographic scapulo-humeral angles, results of manual muscle testing according to the Jones’s classification, and complications (Table 2)
Summary
Fibrous change in muscles may be congenital or secondary to intramuscular injection or direct trauma [1,2,3,4,5,6,7]. In Asian countries, intramuscular injections are used commonly to treat children who have an infection or even only a fever. Shoulder adduction contracture is due to a fibrous long head of the triceps muscle, as identified intraoperatively and confirmed histopathologically. Cosmetic problems include adduction contracture of the shoulder and outward movement of the scapula when the elbow is flexed, dimpling of the skin, and a palpable long head of the triceps (Fig. 2a–d)
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