Abstract
BackgroundVarious approaches have been developed to treat the progressive shoulder deformity in patients with brachial plexus birth palsy. Reconstructive surgery for this condition consists of complex procedures with a risk for failure.Case presentationsThis is a retrospective case review of the outcome in eight cases referred to us for reoperation for failed shoulder reconstructions. In each case, we describe the initial attempt(s) at surgical correction, the underlying causes of failure, and the procedures performed to rectify the problem. Results were assessed using pre- and post-operative Mallet shoulder scores. All eight patients realized improvement in shoulder function from reoperation.ConclusionsThis case review identifies several aspects of reconstructive shoulder surgery for brachial plexus birth injury that may cause failure of the index procedure(s) and outlines critical steps in the evaluation and execution of shoulder reconstruction.
Highlights
Various approaches have been developed to treat the progressive shoulder deformity in patients with brachial plexus birth palsy
Level of evidence: IV The most common musculoskeletal deformity following brachial plexus birth injury is medial rotation contracture of the shoulder, which is often coupled with a limitation of shoulder elevation
In patients who have a longstanding contracture, bony incongruence and posterior subluxation/dislocation will develop in the glenohumeral joint [2,3]
Summary
This case review identifies several aspects of reconstructive shoulder surgery for brachial plexus birth injury that may cause failure of the index procedure(s) and outlines critical steps in the evaluation and execution of shoulder reconstruction. Four and a half years prior she had undergone a release of medial rotation contracture of her right shoulder by a subscapularis tenotomy through an axillary approach, and transfer of the teres major muscle under the long head of the triceps into the teres minor She had active shoulder elevation to 45 degrees with a negative clarion sign. At age 4 years, he underwent release of the subscapularis and pectoralis muscles, axillary nerve neurolysis in the quadrilateral space, and transfer of the latissimus and teres major muscles He presented to our center at age 10 with left shoulder internal rotation, active shoulder elevation to 100 degrees, and a positive clarion sign.
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