Muscle Transfer for Shoulder Reconstruction in Obstetrical Brachial Plexus Lesions

Abstract

A prospective study was performed on a group of 32 consecutive obstetrical brachial plexus lesions (OBPL). Seventeen were girls and 15 were boys with an age ranging between 2.3 years to 7 years (mean 3.5 years). Patients were treated operatively for a functionally disturbing unilateral internal rotation contracture of the shoulder with a good deltoid function (grade IotaIota or greater) and no significant active external rotation. The Hoffer technique of muscle transfer in the form of transferring the latissimus dorsi and teres major muscles to the rotator cuff posteriorly through a transaxillary approach with or without subscapularis muscle release was used in all cases. Preoperatively the patients were assessed clinically according to the modified Gilbert shoulder grading system. All patients were of grade 1 and 2. Eighteen patients had a lesion of the superior trunk of the brachial plexus (C5 and C6 roots) and ten patients had various degrees of involvement of the entire plexus while in four patients previous microsurgery reconstruction was performed. All patients improved to grade 4 and 5. The follow-up period ranged from 1.5 to 3.5 years (mean 2.3 years). There were no significant complications except for recurrence of minimal internal rotation in six patients that required no further surgery. Our results suggest that the Hoffer technique for shoulder reconstruction in OBPL is a reliable and safe technique.