Latissimus dorsi versus latissimus dorsi and teres major transfer for the treatment of internal rotation contracture of the shoulder in brachial plexus birth palsy

Abstract

Introduction Although there is now almost universal agreement that the internal rotation contracture of the shoulder should be treated, there is little consensus on how to accomplish this. In this retrospective case study, we compare the results of subscapularis sliding combined with either latissimus dorsi or latissimus dorsi and teres major transfer o the rotator cuff for the treatment of this problem. Patients and methods We retrospectively analyzed 63 patients with an internal rotation contracture of the shoulder secondary to brachial plexus birth palsy. They were treated with subscapularis sliding combined with either latissimus dorsi transfer (group A: n =18) or latissimus dorsi and teres major transfer (group B: n =45) to the rotator cuff. The age of the patients at the time of surgery ranged from 8 months to 9 years (average: 42.71±20.64 months). The average postoperative follow-up was 19.43±11.41 months (range: 12–72 months). We used a modification of the Gilbert shoulder grading system for assessment of patients. Results All the patients showed a statistically significant improvement in active shoulder abduction, external rotation, and Gilbert grade, but the differences between the two groups were not highly significant. However, there was a statistically significant higher incidence of external rotation contracture in group B. Conclusion Subscapularis sliding and latissimus dorsi transfer to the rotator cuff is a satisfactory treatment, with a significantly lower incidence of developing external rotation contracture compared with combined latissimus and teres major transfer. Our modifications of the Gilbert grading system aid the classification of all kinds of cases and have prognostic significance.