Bidirectional Double Muscle Transfer to Restore Shoulder Abduction and External Rotation in Late Obstetric Brachial Plexus Injuries

Muhammad Aurangzeb Ahmad

doi:10.4172/2161-1076.1000216

Abstract

Background: Internal rotation contracture is the most frequent and important secondary deformity of the shoulder in birth palsy. Many techniques have been tried to solve this problem. Aim: To improve shoulder abduction and external rotation in obstetric brachial plexus injuries (OBPIs) by performing an ordinary Single Muscle Transfer (SMT) or Bidirectional Muscle Transfer (BMT) around the shoulder. Patients and methods: 40 patients: 21 male and 19 female their age ranged from 2 to10 years complaining of lake of shoulder abduction and external rotation due to OBPIs. They were divided into two groups according to the performed operation: group 1 (17 patients) operated with BMT and group 2 (23 patients) operated with SMT. Results: There was significant postoperative improvement in shoulder abduction, external rotation and flexion in both procedure “BMT and SMT”. In addition, the young age gives better results as there are negative correlation between patient age and degree of shoulder functions improvement in both groups. Moreover, BMT procedure had significant higher degree of improvement in shoulder abduction and external rotation than SMT procedure. Conclusion: Bidirectional muscle transfer is recommended as an optimal procedure to improve shoulder abduction and external rotation in late obstetric brachial plexus injuries.

Highlights

Obstetric brachial plexus injuries (OBPIs) is a mixed nerve and musculoskeletal complication that happens during the process of difficult delivery [1]
The fast limb growth with marked asymmetry in the pathology of nerve involvement within the brachial plexus, may lead to a lot of sequelae as muscle contracture, weakness, and imbalances. These deformities become more evident with failure of growth of the denervated muscles, or at least developed at a lower rate than the antagonist innervated muscles
Teathering effect may develop gradually, that limits the passive range of motion around the shoulder joint

Summary

Introduction

Obstetric brachial plexus injuries (OBPIs) is a mixed nerve and musculoskeletal complication that happens during the process of difficult delivery [1]. The fast limb growth with marked asymmetry in the pathology of nerve involvement within the brachial plexus, may lead to a lot of sequelae as muscle contracture, weakness, and imbalances. These deformities become more evident with failure of growth of the denervated muscles, or at least developed at a lower rate than the antagonist innervated muscles. Muscle imbalances and contractures can lead to a lot of bony deformities [3]. Bony deformities can result from decreased innervation from the brachial plexus to shoulder joint bones [4,5].

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