Abduction Contracture Research Articles

Impact of tendon transfer on scapulothoracic and glenohumeral motion in children with brachial plexus birth injuries

BackgroundTendon transfers are often utilized to improve shoulder external rotation and abduction in children with brachial plexus birth injuries and are designed to improve glenohumeral (GH) joint motion. However, changes in scapulothoracic (ST) and glenohumeral (GH) joint function after tendon transfer are not well defined. The purpose of this study was to quantify changes in GH, ST, and humerothoracic (HT) joint function before and after tendon transfer, and we hypothesized that tendon transfers would reorient the arc of motion into more external rotation and abduction, but not increase GH motion. MethodsMotion analysis was performed in 15 children (ages 3-16) before and after transfer of teres major and/or latissimus dorsi. Scapulothoracic, GH, and HT joint angles were measured in a neutral, resting position and each of the modified Mallet positions. Joint angular displacements from the neutral position and the total arc of internal-external rotation for each joint were also calculated. Relevant joint angles, joint angular displacements, and internal-external rotation arcs were compared using multivariate analyses of variance with repeated measures and univariate post-hoc analyses. ResultsGlenohumeral and HT external rotation were significantly increased in all positions postoperatively. The arc of GH internal-external rotation was unchanged, but oriented in more external rotation after surgery. Only 6 patients gained active external rotation. Glenohumeral and HT internal rotation were significantly decreased after surgery, but ST internal rotation was significantly increased. Two patients had loss of midline function. In the abduction position, GH elevation joint angles were unchanged, but ST and HT elevation increased. DiscussionOnly four patients gained active GH external rotation and maintained their internal rotation. Each of those patients underwent isolated tendon transfer without concomitant joint release. Seven patients maintained their preoperative internal rotation, which was attributed to increased ST internal rotation. The other half of patients lost internal rotation and gained external rotation through reorientation of the arc of rotation. Nine patients gained HT elevation, with three attributed to increased ST upward rotation, five attributed to a combination of increased ST upward rotation and increased GH elevation, and one attributed to increased GH abduction contracture. These findings challenge the dogma that teres major/latissimus dorsi tendon transfers augment GH motion and highlight the importance of ST function for outcome determination.

The Putti Sign Following Residual Brachial Plexus Birth Injury: Prevalence and Significance.

The Putti sign, a common deformity and complaint in children with brachial plexus birth injury (BPBI), stems from a glenohumeral (GH) abduction contracture. Despite recent clinical studies offering insights into this deformity, none have explored the prevalence of the Putti sign or its correlation with GH abduction contractures. We conducted a prospective analysis of 238 patients (median age 7.5 years; range, 4.1-16.2) with residual BPBI seen in the clinic from December 2019 to December 2022. Epidemiological data, including demographics, palsy levels, modified Mallet scale sum, surgical history, and presence/absence of the Putti sign and glenohumeral adduction angle (GHADD), were collected. Patients were categorized into 4 age groups: 0 to 5 years (n=67), 6 to 10 years (n=102), 11 to 15 years (n=53), and 16 years and older (n=16). Results were expressed as medians (minimum-maximum), with frequency comparisons done using Pearson's chi-square analysis. Mann-Whitney U and Kruskal-Wallis tests were used for quantitative variable comparison, and receiver operating characteristic (ROC) analysis determined the threshold GHADD angle for Putti sign appearance. Main findings included: (1) 27% of patients with residual BPBI exhibited the Putti sign, (2) confirmed correlation between the Putti sign and GH adduction contractures, (3) Putti sign manifestation with GHADD angle measuring less than -5° because to abduction contracture, and (4) association between this deformity and reduced activities requiring external rotation. No significant differences in Putti sign prevalence were found across age groups. Our study underscores the common occurrence of the Putti sign in children with residual BPBI. It is important to note that we highlight its functional significance beyond cosmetic concerns. Contrary to prior literature, our analysis reveals functional impairment associated with the Putti sign. Although no age-based differences in Putti sign prevalence were observed, patients aged 0 to 5 years and 11 to 15 years showed more severe glenohumeral abduction contractures, possibly due to growth spurts. Diagnosis IV.

Correction of Congenital Ring-Little Finger Metacarpal Synostosis Through Simultaneous Interpositional Allograft Bone After Split Osteotomy of the Synostosis Site and Distraction Lengthening of the Fifth Metacarpal

We attempted a technique for patients with congenital ring-little finger metacarpal synostosis involving simultaneous interpositional allograft bone after split osteotomy of the synostosis site and distraction lengthening of the fifth metacarpal along with correction of the metacarpal joint abduction contracture. The purpose of this study was to describe the surgical technique and its outcomes. We reviewed the medical records of children with congenital ring-little finger metacarpal synostosis treated surgically at our institute. Eight hands of six children with an average age of 5.0 (range, 1.7-9.3) years were treated by simultaneous interpositional allograft bone after split osteotomy, distraction lengthening, and tenotomy of abductor digiti minimi. We measured the metacarpal head-to-capitate area ratios from serial radiographs and analyzed them according to age. We also measured the change in the intermetacarpal angle (IMA) and metacarpal length ratio during an average of 8.1 (range, 1.4-16.8) years of follow-up. These changes were compared with changes in seven hands of five children with an average age of 8.1 (range, 1.5-15.6) years treated by the same method, but without a distraction lengthening of the fifth metacarpal and followed up for an of average 12.1 (range, 4.1-19.8) years, as a control group. Abnormal metacarpal head-to-capitate area ratio before surgery was normalized in all patients within the first 2 years after surgery. The IMA change averaged 39.8°, and the metacarpal length ratio changed by 17%. The control group showed an average IMA change of 36.6° and metacarpal length ratio change of 6%. Simultaneous interpositional allograft bone after split osteotomy of the synostosis site and distraction lengthening of the fifth metacarpal with correction of metacarpal joint abduction contracture can restore the radiographic parameters in congenital ring-little finger metacarpal synostosis. The normalized ossification of the fifth metacarpal head indicates that the surgical procedure is probably safe. Therapeutic V.

Разгибательно-отводящая контрактура тазобедренных суставов как следствие фиброза ягодичных мышц

Abstract. Introduction The disease that is manifested by primarily induced fibrotic changes in the gluteal muscles resulting in hip contractures and, in particular, in extension-abduction contracture of the hip joints has been known in the English literature as the “gluteal muscle contracture” and “gluteal fibrosis”. The world literature on the subject covers this pathology mostly in pediatric and adolescent patients, whereas this disease has not been sufficiently discussed in the adult patients, even in foreign studies. Therefore, diagnostic methods, methods of examination and treatment of adult patients have not been systematized and this nosology presents certain clinical and diagnostic difficulties for many domestic orthopedists. Materials and methods We searched the PubMed and eLibrary systems for studies on the topic and used combinations of key words “gluteus muscle contracture”, “gluteal fibrosis”, “gluteus maximus contracture”, “abduction contracture of the hip”, ”extension-abduction contracture of the hip”, “aplasia of gluteal muscles” published from October 1974 to February 2020 and found a total of 106 results. The first publication coincides with the date of the initial search period. The criteria for including studies in the analysis were a discussion of the issues of etiology and pathogenesis, epidemiology, diagnostic criteria, clinical presentation, and approaches to the treatment of this pathology. We excluded articles related to the installation of gluteal implants and other pathology of the gluteal region, so the number of articles decreased to 67, what means little investigation of this problem. Results Our analysis showed that out of 67 articles, only 9 articles were related to issues of etiology and pathogenesis, five articles dealt with epidemiology, 15 dealt with diagnostic criteria, treatment options were described in 12 articles, and the majority of publications focused on the results of surgical treatment of clinical samples including 1-2 to 1280 cases. In the context of the 50-year-old depth of the literature search, the analysis indicates the fragmentation of the material devoted to the gluteal muscle fibrosis published over this period of time, which requires the systematization and generalization of the literature data accumulated to date. Conclusion Gluteal fibrosis is a rare independent disease, which is prevalent among certain ethnic groups. The extension-abduction contracture of the hip joint develops due to gluteal fibrosis, the clinical picture of which has been very well documented and has specific radiological signs. Surgical treatment methods vary, from open to endoscopic treatments and minimally invasive techniques. Since the main group of patients described in the literature is children and adolescents and the surgical methods used are discussed for these age groups, treatment methods and their efficacy for adult patients have been little reported. Therefore solution making is difficult for patients older than 18 years. It primarily refers to providing specialized orthopedic care in places where ethnic groups with this pathology reside.

Glenohumeral abduction contractures after residual neonatal brachial plexus injury.

Glenohumeral abduction contractures are common in patients with neonatal brachial plexus injury, but little has been previously published about them. We conducted a retrospective analysis of data prospectively collected from 205 consecutive children (108 female) of mean age 9.6years with neonatal brachial plexus injury (C5-C6, 58%; C5-C7, 29%; C5-T1, 14%). Most children (69%) showed a glenohumeral abduction contracture, it being more common in those with upper neonatal brachial plexus injury.Level of evidence: III.

Effect of Glenohumeral Reduction Type Combined With Tendon Transfer for Brachial Plexus Injury on Objective, Functional, and Patient-Reported Outcomes

Glenohumeral (GH) joint reductions are frequently performed during tendon transfer surgery for brachial plexus birth injuries (BPBI); however, the effect of reduction method (none required, closed, surgical) has not been assessed. This study compared objective, functional, and patient-reported outcomes between children who underwent a tendon transfer and (1) did not require GH reduction, (2) required concomitant closed GH reduction, or (3) required concomitant surgical GH reduction. Fifty-four children with BPBI who previously underwent teres major and/or latissimus dorsi transfer with or without concomitant GH reduction participated. Joint reduction method was classified as none required (n= 21), closed (n= 9), or surgical (n= 24). Motion capture was collected in a neutral position, abduction, external rotation, and internal rotation. Glenohumeral joint angles and displacements were calculated. Joint angular displacements represented the differences between the joint angles in each terminal position and the joint angles of the arm at rest in the neutral position. A hand surgeon determined modified Mallet scores. Participants' parents completed the Brachial Plexus Profile Activity Short Form (BP-PRO-SF) to assess physical activity performance. The no-reduction group had significantly less GH elevation than the surgical-reduction group for all positions and significantly less GH elevation than the closed-reduction group for the neutral, external rotation, and internal rotation positions. There were no differences in GH rotation angles. Glenohumeral joint displacements from neutral and modified Mallet scores were similar. The no-reduction group demonstrated significantly greater BP-PRO-SF scores than the surgical-reduction group. Patients who underwent a closed or surgical GH joint reduction consistently displayed more GH elevation. Clinically, this corresponds to an abduction contracture. Whereas increased abduction contracture provided a benefit of greater overhead motion, modified Mallet scores were similar between groups. The surgical-reduction group demonstrated lower BP-PRO-SF outcomes. Therapeutic IV.

Hip subluxation and osteophye morphology are related to coronal contracture of the hip.

Coronal hip contracture induces pelvic obliquity in the presence of hip osteoarthritis (HOA), followed by the functional leg-length discrepancy. To promote accurate diagnosis of contracture and proper management of soft tissue release in total hip arthroplasty (THA), this study aimed to clarify the morphological features on plain radiographs that are related to contracture in patients with HOA. Two hundred forty-three hips of 231 patients with HOA who underwent primary THA were included in this study. Preoperative pelvic radiographs of the bilateral hips in maximum adduction and abduction were used to quantify contracture. Patients were grouped according to their contracture as having abduction contracture, adduction contracture, or minimal contracture. We investigated HOA, subluxation, anatomical factors, spinal factors, and the morphology of osteophytes at the inferomedial femoral head and compared parameters among groups to clarify the predictors of contracture. Eighteen hips (7.6%) were classified as having adduction contracture and 23 (9.4%) as having abduction contracture. Crowe classification, leg-length discrepancy, and osteophyte morphology showed significant correlations with adduction contracture. Factors significantly correlated with abduction contracture were offset difference, pelvic obliquity, functional femoral anteversion, and osteophyte morphology. Multivariate logistic regression analysis showed that the factor most strongly related to adduction contracture was Crowe III classification, whereas the strongest predictor of abduction contracture was osteophyte morphology. In conclusion, hip subluxation was related to the adduction contracture of the hip, whereas osteophyte morphology was related to abduction contracture.

Suture Suspension Arthroplasty With Trapeziectomy for Thumb Carpometacarpal Arthritis Using a Wide-awake Approach.

Despite the introduction of various techniques for ligament reconstruction in the treatment of thumb carpometacarpal (CMC) arthritis, complications, including proximal migration, dorsal subluxation of the first metacarpal base, hyperextension of the thumb metacarpophalangeal joint, and impingement between the first and second metacarpal bases, have been reported. Even suture button suspensionplasty with Arthrex Mini TightRope may be unable to correct the adduction contracture deformity and does not effectively tether the trapeziometacarpal toward the base of the index metacarpal, thus potentially leaving patients with persistent decreased first web space angle, proximal migration, and collapse deformity. Hence, suture suspension arthroplasty with abductor pollicis longus (APL)-flexor carpi radialis (FCR) tendon suture after trapeziectomy, a simpler technique, was applied. This simple surgical reconstruction abducts the first metacarpal bone. Abduction of the CMC joint improves metacarpophalangeal joint hyperextension. However, strong tension of the APL-FCR causes abduction contracture of the first CMC joint and difficulty of pinch motion of the thumb to the other fingers. Therefore, we have modified the arthroplasty with a wide-awake approach. The procedure is performed with the patient fully awake under local anesthesia, without a tourniquet to allow the patient to actively move and pinch the thumb, which allows the surgeon to confirm the tension of the APL-FCR suture. A fiber wire is connected to the APL-FCR with proper tension. The patient and surgeon can ensure pinch motion and thumb opposition with satisfaction during surgery.

Symptomatic rotator cuff tears frequently associated with abduction contracture

Why some rotator cuff tears are asymptomatic is not well-understood. We measured the glenohumeral adduction angle (GAA) with scapular fixation and proved that patients with shoulder stiffness and/or rotator cuff tear usually had abduction contracture. Our study aimed to (1) check the frequency of abduction contracture, (2) measure GAA, and (3) evaluate the result of adduction manipulation among patients with symptomatic rotator cuff tear.

Effect of Closed Versus Surgical Glenohumeral Reduction on Glenohumeral Function in Children With Brachial Plexus Birth Injuries

Grant support received from: Shriners Hospitals for Children Clinical Research Grant (2016-2018) Royalty: Osteomed, Arthrex (Zlotolow) Receipt of Intellectual Property Rights: McGinley Orthopaedics (Kozin and Zlotolow) Consulting Fee: ADMT, Checkpoint Surgical (Kozin), Osteomed (Zlotolow) Speaker's Bureau: Osteomed (Zlotolow) Contracted Research: AxoGen (Zlotolow) Ownership interest: McGinley Orthopaedics (Zoxin and Zlotolow) Closed or surgical glenohumeral (GH) joint reductions are frequently performed during tendon transfer surgery for brachial plexus birth injuries (BPBI); however, their effects on GH joint function are unknown. We hypothesized that children with no reductions would have better GH joint motion, Mallet scores, and patient-reported outcomes compared with closed and surgical reductions. Fifty-four children with BPBI (age 4–17 years) who previously underwent transfer of latissimus dorsi and teres major or teres major alone with or without concomitant GH reduction participated. Glenohumeral joint reduction method was classified as (1) none when the GH joint was concentric preoperatively (n = 21), (2) closed (n = 9), or (3) surgical when the capsule was incised (n = 24). Surgical reductions were performed when closed reduction failed to provide adequate improvement in GH alignment. Three-dimensional motion capture in a neutral position (arm resting by side) and a subset of the Mallet positions targeting elevation and/or external rotation: abduction, external rotation, and hand-to-nape. Glenohumeral joint angles were calculated using a modified globe method. Glenohumeral joint angular displacements were calculated from the neutral position to each tested position. A hand surgeon determined modified Mallet scores. Participants’ caretakers completed the brachial plexus computer adaptive test short form (BP-CAT-SF) to assess physical activity performance (average t-score = 50, standard deviation = 10). One-way ANOVAs (α = 0.05) with Bonferroni post-hoc comparisons were utilized to compare groups. The surgical reduction group demonstrated significantly greater GH elevation than the no reduction group in all positions, and the closed reduction group demonstrated significantly greater GH elevation in the neutral and external rotation positions (Table 26-1, Figure 26-1). The closed reduction group demonstrated greater GH external rotation displacement in the hand-to-nape position. Average Mallet score differences were not significantly different. The no reduction group exhibited significantly (P = .005) better BP-CAT-SF scores than the closed and surgical reduction groups (t-scores = 59, 55, and 54, respectively). •Overall, groups demonstrated similar GH displacements to perform the positions, but the surgical and closed reduction groups had greater GH elevation at rest and this difference was maintained during most of the tested positions. These findings are consistent with GH reduction producing a GH abduction contracture.•Patients with no reduction had better BP-CAT-SF scores than those with closed and surgical reductions, although the clinical difference was small. Further investigation regarding the relationships between objective outcome measures and BP-CAT-SF is needed.•Although patients who required surgical reduction likely had more severe preoperative GH joint pathology, the changes in Mallet scores were similar between all groups.Table 26-1Mean (standard deviation) GH joint angles in degrees.Axis of MotionPositionNo Reduction (n = 21)Closed Reduction (n = 9)Surgical Reduction (n = 24)P valueGH ElevationNeutral30.5 (8.6)*†51.6 (18.1)*47.9 (14.7)†.001Abduction59.1 (16.3)*71.2 (26.3)73.1 (15.2)*.028Hand-to-Nape54.3 (15.8)*67.6 (12.9)67.2 (17.0)*.015External Rotation39.4 (14.0)*†54.8 (17.7)*56.4 (15.9)†.001GH External RotationNeutral27.7 (21.8)13.9 (25.6)19.0 (22.6).143Abduction37.9 (24.0)30.8 (31.1)24.9 (32.9).212Hand-to-Nape41.5 (21.7)51.4 (21.1)33.2 (28.8).137External Rotation31.7 (26.2)26.4 (27.4)22.4 (26.4).382P values of the one-way ANOVA are included. Groups that were significantly different from each other with the post-hoc Bonferroni comparisons are indicated by * and †. Open table in a new tab P values of the one-way ANOVA are included. Groups that were significantly different from each other with the post-hoc Bonferroni comparisons are indicated by * and †.

Congenital contracture of the iliotibial tract: a case report

Introduction. Congenital contracture of the iliotibial tract is a rather rare pathology that causes difficulties in diagnosing and planning treatment activities. The lack of a clear idea of the causes of the disease has led to disagreement in the interpretation of the diagnosis in patients with this pathology. In the Russian-language literature, this disease is referred to as idiopathic extension and abduction contracture of a hip joint or idiopathic contracture of the dorsal gluteal muscle (a congenital contracture of the tendons of the dorsal gluteal muscles), whereas the English-language literature more often highlights congenital or idiopathic contracture of the dorsal gluteal muscles.
 Clinical сase. The results of treatment of a 6-year-old child with congenital contracture of the iliotibial tract is presented. The child exhibited lameness when walking first started, but the correct diagnosis was not established. Clinically, along with the limitation of adduction and extension in the hip joint and an induration of the soft tissue along the external surface of the right thigh, the pelvis was skewed, and there was shortening of the right lower limb and a valgus deformity of diaphysis of the right femoral bone. Ultrasonographic and magnetic resonance imaging indicated the presence of a fibrous bridle over the outer surface of the right thigh. The fibrous bridle was excised for 15 cm, and a temporary hemiepiphysiodesis of the medial portion of the distal growth zone of the right femur was performed.
 Results and discussion. At the 1-year control examination, the patient did not present any complaints. There was no relapse of the contracture. According to X-ray study results, correction of the valgus deformity of the right femur was achieved, and the metal structures were removed. Despite the more frequent extension and abduction direction of the contracture of the iliotibial tract indicated by most authors, the direction and severity apparently may depend on the predominant zone of fibrous degeneration of the muscle groups. Additionally, with the predominant lesion of the dorsal gluteal muscle, a more pronounced extension component can be expected, whereas with the predominant lesion of the musculus tensor fasciae latae, a flexion component can be expected and was observed in our patient.

Proximal femoral osteotomy in Legg-Calvé-Perthes disease using a monolateral external fixator: surgical technique, outcome, and complications.

Level IV, case series.

Prevalence of hallux valgus among medical students of the University of Jos

Introduction: Hallux Valgus is defined as a deformity characterized by abduction contracture in which the great toe is turned away from the mid-line of the body. The aim of this study was to examine and evaluate the prevalence of hallux valgus among the Medical Students of University of Jos, Nigeria in age and gender subgroups. Materials and Methods: This study was a cross sectional and observational study involving 200 volunteers (100 females and 100 males) aged between 18 and 30 years with mean age of 24.6 years and standard deviation of 3.4 years. Informed consent was obtained and subjects were examined and assessed for the presence or absence of hallux valgus adopting a standard photograph. Data obtained from this research study was analyzed using IBM SPSS version 20. Results: An overall prevalence of hallux valgus deformity in the studied population was 16% with a higher prevalence in females (11%) than their male counterparts (5%). There is a higher prevalence of hallux valgus deformity in the older age group than can be seen in the younger age group. Conclusion: Young women and indeed the general public need to be more aware of the Hallux Valgus deformity and its relationship to footwear and therefore take proactive measures to prevent this deformity.

Gluteal muscle fibrosis with abduction contracture of the hip.

Gluteal muscle fibrosis with hip contracture is a rare condition and causes major disability; literature reports are sparse. The aim of this study is to present, for the first time in Iraq and the region, a case series of gluteal fibrosis and the results of surgical treatment. Seven children--six boys and one girl--diagnosed as having gluteal muscle fibrosis with hip contracture, were investigated and treated by open surgical release of fibrotic bands and physiotherapy. All patients improved dramatically over the subsequent weeks, and were able to sit and squat in the normal position. Gluteal muscle fibrosis with hip contracture is present in Iraq and more awareness is needed for early diagnosis. Surgical treatment provided excellent results. More studies are needed to delineate the aetiology of the condition.

Limited glenohumeral cross-body adduction in children with brachial plexus birth palsy: a contributor to scapular winging.

Approximately 1 of every 1000 live births results in life-long impairments because of a brachial plexus injury. The long-term sequelae of persistent injuries include glenohumeral joint dysplasia and glenohumeral internal rotation and adduction contractures. Scapular winging is also common, and patients and their families often express concern regarding this observed scapular winging. It is difficult for clinicians to adequately address these concerns without a satisfying explanation for why scapular winging occurs in children with brachial plexus birth palsy. This study examined our proposed theory that a glenohumeral cross-body abduction contracture leads to the appearance of scapular winging in children with residual brachial plexus birth palsy. Sixteen children with brachial plexus injuries were enrolled in this study. Three-dimensional locations of markers placed on the thorax, scapula, and humerus were recorded in the hand to mouth Mallet position. The unaffected limbs served as a control. Scapulothoracic and glenohumeral cross-body adduction angles were compared between the affected and unaffected limbs. The affected limbs demonstrated significantly greater scapulothoracic and significantly smaller glenohumeral cross-body adduction angles than the unaffected limbs. The affected limbs also exhibited a significantly lower glenohumeral cross-body adduction to scapulothoracic cross-body adduction ratio. The results of this study support the theory that brachial plexus injuries can lead to a glenohumeral cross-body abduction contracture. Affected children demonstrated increased scapulothoracic cross-body adduction that is likely a compensatory mechanism because of decreased glenohumeral cross-body adduction. These findings are unique and better define the etiology of scapular winging in children with brachial plexus injuries. This information can be relayed to patients and their families when explaining the appearance of scapular winging. Level II.

Injection-induced gluteus muscle contractures: diagnosis with the "reverse Ober test" and surgical management.

Adoption rates are increasing in the United States and other developed countries. A large proportion of adopted children have been found to have unsuspected medical diagnoses, including orthopedic problems. One condition, termed injection-induced gluteus maximus contracture, has been previously described in several case series and can be difficult to diagnose if unfamiliar with this condition. By reviewing the etiology and pathoanatomy of this problem, as well as the typical examination findings, including the near-pathognomonic-positive "reverse Ober test," treating providers will be better prepared to recognize and properly treat this condition. This is a retrospective review of 4 patients treated at our institution for injection-induced gluteus maximus contracture. Patient history, physical examination findings, and treatment outcomes were recorded. All had undergone surgical treatment through a longitudinal incision along the posterior margin of the iliotibial band, with division of thickened, contracted gluteus tissue down to the ischial tuberosity. All 4 of the patients were adopted from orphanages in developing countries. Chief complaints of the patients varied, but physical examination findings were very consistent. Three of the 4 patients had undergone rotational osteotomies for presumed femoral retroversion before their diagnosis and treatment for injection-induced gluteus maximus contracture. All patients had concave, atrophic buttock contours and numerous punctate buttock scars. All walked with an out-toed gait and had marked apparent femoral retroversion. Each patient was found to have full hip adduction when the hip was extended but a hip abduction contracture when the hip was flexed. This finding of increasing abduction as an extended/adducted hip is flexed to 90 degrees is described as a positive "reverse Ober test." After surgical treatment, all hips could adduct to neutral from full extension to full flexion. Although common in some countries, such as Russia and China, injection-induced gluteus muscle contractures are seldom seen in the United States and other developed countries. Diagnosis of this condition can be difficult leading to inappropriate treatment. Knowledge of the clinical presentation typical of a gluteus contracture and of the pathognomonic finding of a "reverse Ober test" can facilitate an effective surgical procedure to correct the associated functional impairment. Level IV: retrospective case series.

Glenohumeral abduction contracture in children with unresolved neonatal brachial plexus palsy.

Following neonatal brachial plexus palsy, the Putti sign-obligatory tilt of the scapula with brachiothoracic adduction-suggests the presence of glenohumeral abduction contracture. In the present study, we utilized magnetic resonance imaging (MRI) to quantify this glenohumeral abduction contracture and evaluate its relationship to shoulder joint deformity, muscle atrophy, and function. We retrospectively reviewed MRIs of the thorax and shoulders obtained before and after shoulder rebalancing surgery (internal rotation contracture release and external rotation tendon transfer) for twenty-eight children with unresolved neonatal brachial plexus palsy. Two raters measured the coronal positions of the scapula, thoracic spine, and humeral shaft bilaterally on coronal images, correcting trigonometrically for scapular protraction on axial images. Supraspinatus, deltoid, and latissimus dorsi muscle atrophy was assessed, blinded to other measures. Correlations between glenohumeral abduction contracture and glenoid version, humeral head subluxation, passive external rotation, and Mallet shoulder function before and after surgery were performed. MRI measurements were highly reliable between raters. Glenohumeral abduction contractures were present in twenty-five of twenty-eight patients, averaging 33° (range, 10° to 65°). Among those patients, abductor atrophy was present in twenty-three of twenty-five, with adductor atrophy in twelve of twenty-five. Preoperatively, greater abduction contracture severity correlated with greater Mallet global abduction and hand-to-neck function. Abduction contracture severity did not correlate preoperatively with axial measurements of glenohumeral dysplasia, but greater glenoid retroversion was associated with worse abduction contractures postoperatively. Surgery improved passive external rotation, active abduction, and hand-to-neck function, but did not change the abduction contracture. A majority of patients with persistent shoulder weakness following neonatal brachial plexus palsy have glenohumeral abduction deformities, with contractures as severe as 65°. The abduction contracture occurs with abductor atrophy, with or without associated adductor atrophy. This contracture may improve global shoulder abduction by positioning the glenohumeral joint in abduction. Glenohumeral and scapulothoracic kinematics and muscle pathology must be further elucidated to advance an understanding of the etiology and the prevention and treatment of the complex shoulder deformity following neonatal brachial plexus palsy. Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Pelvic Deformity Secondary to Tensor Fascia Lata Tightness Associated With Desmoid Tumor

The iliotibial band is a thick, condensed fascia that, when contracted, leads to a hip flexion, abduction, and external rotation contracture in addition to other joint contractures. Iliotibial band tightness occurs secondary to iliotibial band friction syndrome, which commonly occurs at the lateral femoral epicondylar region. However, a proximal cause of iliotibial band/tensor fascia lata friction syndrome leading to a secondary hip contracture is swelling around the hip; this swelling being a desmoid tumor has not been explicitly described in the literature. The authors present a rare case of a hip contracture in a 28-year-old active man who presented with a functionally disabling hip flexion contracture of 20° with further flexion possible up to 130°, a 45° abduction contracture, and a 20° external rotation contracture with further rotation possible up to 40° with a bony hard swelling in the left gluteal region. Ober’s test was positive. Opposite hip and spine examinations were normal. The goals of treatment were to establish the causality between the 2 and to diagnose the etiology of the gluteal mass. Radiographs were normal, with only a pelvic obliquity evident. Magnetic resonance imaging revealed an extra-articular mass abutting the iliac blade. Histopathology confirmed the mass to be a desmoid tumor in the left gluteal region. A wide surgical excision of the mass was performed with negative margins; no postoperative radiotherapy was administered. After rigorous physiotherapy, the hip deformity disappeared at 6 months and there was no evidence of recurrence at 2.5-year follow-up, with the patient able to sit cross-legged and squat.

Anterior Dislocation of the Shoulder Due to an Idiopathic Deltoid Contracture-the Report of a Rare Presentation

Post injection fibrosis leading to muscle contracture is a known complication. Deltoid fibrosis is known to occur following trauma or an intramuscular injection. Idiopathic Deltoid fibrosis leading to abduction contracture and anterior dislocation of the shoulder is a rare entity. Prompt diagnosis and surgery by distal release of fibrosed Deltoid muscle will lead to good functional recovery.

Deltoid contracture mimicking shoulder dislocation in a 7-year-old boy

Contracture of the deltoid muscle, a relatively uncommon disorder in children, can be caused by repeated intramuscular injection, trauma, or congenital disease. The typical clinical manifestations of deltoid contracture (i.e., a palpable fibrous cord within the deltoid muscle, abduction contracture of the shoulder, winged scapula, and skin dimpling over the fibrous bands), however, may be atypical or even lacking, thus, leading to misdiagnosis. The procedure going from misdiagnosis to recognition of the correct diagnosis is reviewed in a 7-year-old boy with deltoid contracture.