Treatment of Glenohumeral Arthrosis and Inferior Shoulder Subluxation in an Adult with Cerebral Palsy

Abstract

Spasticity of the shoulder musculature1,2, glenohumeral joint subluxation3,4, or glenohumeral arthrosis5 can contribute to shoulder pain and functional limitation in patients with spasticity. This report describes a patient with chronic upper motor neuron injury from cerebral palsy who underwent shoulder hemiarthroplasty and biceps suspension for treatment of inferior glenohumeral subluxation and arthrosis. The patient was informed that data concerning the case would be submitted for publication, and she provided consent. A fifty-two-year-old right-hand-dominant woman presented with left shoulder pain and deformity. The patient had cerebral palsy characterized by spastic left hemiparesis and athetosis. She noted that the shoulder and elbow deformity became more prominent while she was walking, as is typical of upper motor neuron disorders with spasticity, making balance and walking difficult. She had been diagnosed with severe degenerative osteoarthritis and an inferior glenohumeral subluxation, which had been unresponsive to nonoperative treatment including botulinum toxin injections, intra-articular steroid injections, and a suspension orthosis to reduce the glenohumeral subluxation. On physical examination, the patient had marked spasticity with only minimal volitional movement of the left shoulder. There was no active flexion or extension of the elbow, wrist, or fingers. There were, however, spontaneous athetoid movements of the left upper extremity as well as a positive sulcus sign. Passive shoulder motion was limited by pain caused by underlying arthritis and by increased tone. The resting shoulder posture was 15° of extension, 60° of abduction, and 30° of internal rotation. The left elbow was held in 90° of flexion, although it could be moved passively from 0° to 150°. Radiographs (Fig. 1-A) and magnetic resonance imaging (MRI) (Fig. 1-B) demonstrated advanced degenerative arthritis of the glenohumeral joint and inferior glenohumeral subluxation but no evidence of a rotator cuff tear or other associated intra-articular …