Complete deltoid resection in early childhood without muscle transfer results in normal shoulder function at long-term follow-up: a case report

Annie Arteau,Bruno Fuchs,Franziska Seeli

doi:10.1186/s13256-016-1132-z

Annie Arteau, Bruno Fuchs + Show 1 more

Open Access

https://doi.org/10.1186/s13256-016-1132-z

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Abstract

BackgroundMusculoskeletal tumors involving the deltoid muscle and necessitating its complete resection are rare. The function after complete deltoid resection is reported to be limited, and several authors consider muscle transfer to improve shoulder motion. However, it still remains unclear whether such transfer adds function. To the best of our knowledge, all reports on complete deltoid resection refer to adult patients, and it is unknown what function results after deltoid resection in childhood. The remaining muscles may have the potential to compensate for the loss of deltoid function.Case presentationHere we report the case of a 5-year-old white boy with complete (isolated) deltoid muscle resection in infancy for a large aggressive soft tissue tumor. No reconstructive procedure or muscle transfer was performed at the time of index surgery. Pathology revealed an angiomatoid fibrous histiocytoma. His postoperative course was uneventful. At 11 years of follow-up, he remained disease-free and had excellent shoulder function, including normal range of motion.ConclusionsThis report implies that major muscles such as the deltoid can be resected in a child without compromising long-term function. Therefore, a muscle transfer at index surgery is probably not necessary.

Highlights

BackgroundMost of the knowledge related to deltoid dysfunction stems from patients with non-neoplastic pathologies such as brachial plexus injuries, axillary nerve palsy secondary to shoulder luxation, iatrogenic nerve or muscle lesions, or after poliomyelitis [1, 2]
Musculoskeletal tumors involving the deltoid muscle and necessitating its complete resection are rare
This report implies that major muscles such as the deltoid can be resected in a child without compromising long-term function

Summary

Background

Most of the knowledge related to deltoid dysfunction stems from patients with non-neoplastic pathologies such as brachial plexus injuries, axillary nerve palsy secondary to shoulder luxation, iatrogenic nerve or muscle lesions, or after poliomyelitis [1, 2]. Ten years after the complete deltoid resection, he is free of disease and his shoulder function remains excellent When compared to his left side, the range of motion of his right shoulder is symmetrical and normal (Fig. 3). Normal rotator cuff muscles and good centralization of the humeral head were observed without degenerative changes on a recent MRI at 11 years of follow-up (Fig. 4) His Musculoskeletal Tumor Society Score (MSTS; a score widely used in orthopedic oncology; it addresses pain, function, emotions, hand positioning, manual dexterity, and lifting ability) for upper extremity is excellent (93.3%), his Constant Shoulder Score (a score widely used in shoulder surgery; it addresses pain, activity of daily living, arm positioning, range of motion, and abduction power) is 75.8% on his

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