Libération antérieure de l’épaule associée à la neurotisation du nerf suprascapulaire par le nerf spinal accessoire chez les enfants présentant une paralysie obstétricale du plexus brachial – résultats préliminaires à propos de 10 cas

Abstract

Introduction Children with obstetric brachial plexus palsy (OBPP) have usually a motor weakness of shoulder external rotation, which results into a contracture of the internal rotators muscles and deformity of the glenohumeral joint. The aim of this study was to assess results of anterior shoulder release combined with neurotization of suprascapular nerve by spinal accessory nerve in children with OBPP. Material and methods Between 2012 and 2015, ten children (mean age: 2.5 years) were operated for a limitation of passive and active external rotation and a limitation of shoulder abduction. Pre and postoperative passive and active shoulder range of motion were measured. Shoulder strength and function were respectively assessed by the Medical Research Council (MRC) score and the Mallet score. MRI was performed to evaluate the glenohumeral joint. Results At mean follow-up of 2.7 years, mean passive external rotation significantly increased from −20° to 70° postoperatively ( P = 0.008). Mean postoperative active external rotation was 50°, while no patient had an active external rotation preoperatively ( P = 0.004). Mean active abduction recovery was 110°. According to MRC score, external rotation strength was graded M4, M3 and M2 in respectively 3, 4 and 3 patients. Similarly, shoulder abduction strength was graded M4, M3 and M2 in respectively 4, 5 and 1 patients. Mallet score demonstrated significant improvements. Joint alignment was obtained with a remodeling of the deformity. Discussion Spinal accessory nerve is a purely motor nerve whose function is similar to the suprascapular nerve. Anterior release is a minimally invasive procedure, which aims to restore external rotation and abduction of the shoulder. Conclusion Anterior shoulder release combined with neurotization of suprascapular nerve by spinal accessory nerve improves significantly shoulder function in children with OBPP.