Assessment Of Active Shoulder Rotation After Tendon Transfer Around The Shoulder In Cases Of Residual Brachial Plexus Injury

Abstract

Background: Active range of motion were analyzed as the outcomes of tendon transfer around the shoulder in children who had internal rotation contracture deformities secondary to obstetric brachial plexus palsy (OBPP) to improve the shoulder external rotation. Regarding to importance of external rotation there was some limitation of internal rotation which can affect patient’s daily activities. Methods: 50 patients with brachial plexus injury who underwent tendon transfer (teres major or latissimus dorsi) with or without anterior shoulder release in two separate incisions. Coracohumeral ligament release and Subscapularis release were done for all patients through anterior incision. A separate second incision in the posterior axillary fold was carried out to perform rerouting of the teres major or latissimus dorsi tendon. Results: The average active external rotation in abduction increased from 23.5o preoperatively to 76.4o postoperatively. The average active external rotation in adduction increased from 9.6o to 77.5o. The average shoulder abduction increased from 74.5o to 142.6o. Active internal rotation was analyzed just after operation, 6 month after and one year after. There was limited active IR in adduction from 10o to 50o with mean average 28.21o and improvement gradually with physiotherapy. Conclusions: Anterior shoulder release combined with latissimus dorsi or teres major rerouting significantly improved global shoulder function, but with limitations of active internal rotation which improving significally with physiotherapy.