Libération capsulaire isolée arthroscopique pour l’enraidissement en rotation interne de l’épaule, séquelle de paralysie néonatale du plexus brachial. Résultats cliniques d’une cohorte prospective de 28 cas avec suivi de 2 ans

Abstract

The limitations of shoulder mobility in external rotation and elevation are the most frequently observed late deficits in neonatal paralysis of brachial plexus. These limitations represent both a sequel (paralysis) and a complication (stiffness). Methods of shoulder release have enabled the possibility of recuperation of active mobility in external rotation. Recently, interest turned to arthroscopic procedures. Indications still remain unclear. The primary objective was to evaluate passive and active gain of external rotation in children with internal contraction, sequel brachial birth palsy after arthroscopic isolated capsular release. The secondary objective was to evaluate the passive and active gain of anterior elevation and internal rotation. This is a monocentric prospective study about the surgical procedure started in 2011. Inclusion criteria were any children over 2 years, with a limited range of motion of the shoulder secondary to brachial plexus birth palsy with active external rotation with elbow at side ≤ 30° and or active anterior elevation ≤ 90°. Non-inclusion criteria were a history of previous palliative surgery, and parents and or child who were reluctant to surgery. The same clinical evaluation was done preoperatively, at 6 weeks, 3 months, 6 months, 1 and 2 years of follow-up. Was noted the passive gleno-humeral, passive global (addition of gleno-humeral and scapulo-thoracic motion) and active global mobility movements for external rotation arm at side (ER1), anterior elevation (AE) and internal rotation arm at side (IR1). Mallet classification was used for functional assessment. Surgery was a capsulo-ligamentar release preserving subscapularis. Statistical analysis compared preoperative and 2 years follow-up values. Results Between 2011 and 2015, 35 patients were included and 28 completed the follow-up at 2 years. Active ER1 average gain was 35° (P