Clinical Outcomes of Arthroscopic Subscapularis Release for Obstetric Brachial Plexus Palsy with Internal Rotation Shoulder Conracture

Abstract

Abstract Objective: Prospective evaluation of arthroscopic subscapularis release in the treatment of internal rotation shoulder contracture associated with obstetric brachial plexus palsy. Patient and Methods: This prospective study was conducted over seven years (between 2012 and 2018), and included 28 patients who were presented with shoulder internal rotation contracture secondary to obstetric palsy before the age of 6 years with passive external rotation less than 10°. They were treated with shoulder arthroscopy to release the subscapularis tendon without any tendon transfer. The average age was 3 years (2 – 5 years). Twenty-two children had an injury at C5 C6, four had an injury at C5 C6 C7 and two had a complete injury. The average follow-up was 27 months (24 - 36 months). Results: At the latest follow-up, passive ER was 70° on average (40° - 90°) and active ER was 60° (20° - 90°). The mean global Mallet score improved from 11.29 ± 1.06 SD (range from 10 to 13) preoperatively to 17.38 ± 2.14 SD (range from 13 to 20) postoperatively. There were no intraoperative or postoperative complications. Conclusion: Arthroscopic Subscapularis Release for internal rotation contracture in OBPP is a minimally invasive procedure and shows promising results in the younger age groups. Keywords: Shoulder arthroscopy; Obstetric Brachial Plexus Palsy; Shoulder internal rotation contracture; Subscapularis release.