Shoulder In Children Research Articles

Management of traumatic fracture-dislocation of the shoulder in children: A systematic review of published case reports

Proximal humerus fracture with simultaneous shoulder dislocation in children is a rare occurrence, with few reported cases. This systematic review of case reports aimed to document the outcomes of different treatment methods. A comprehensive literature search from 1980 to 2024 included case reports on traumatic shoulder fracture-dislocation in children. Eighteen studies were included, with a mean follow-up of 1.5 years. The cases comprised 7 boys and 11 girls, aged between 11 months and 16 years (median 6 years). The cases were divided into two groups based on epiphyseal involvement. Group A had 11 cases (61%) with epiphyseal involvement, while Group B had 7 cases (38%) with metaphyseal fractures without epiphyseal involvement. Treatments included closed or open reduction, with or without internal fixation. All fractures healed in an average of 7 weeks, with full function restored in an average of 21.58 weeks. The review suggests that open reduction with K-wire fixation is optimal for Group A, whereas closed reduction with intramedullary fixation is more effective for Group B, offering satisfactory clinical and radiological results in a shorter time efficiently.

Management of traumatic fracture–dislocation of the shoulder in children: A systematic review of published case reports

Purpose Proximal humerus fracture occurring simultaneously with shoulder dislocation in children is extremely rare, with only a few reports of such cases having been reported. A systematic review of case reports was conducted to document outcomes after different treatment methods. Methods A systematic search of literature from 1980 to 2021 was performed from the PubMed/Medline, ScienceDirect, and SCOPUS databases. All case reports on traumatic fracture dislocation of the shoulder in children were included. Results A total of 18 studies were included with a mean follow-up of 1.5 years. There were 7 boys and 11 girls with an age range from 11 months to 16 years with a median of 6 years. These cases were grouped into two, based on the involvement of the epiphysis with fracture–dislocations. In group A, there were 11 cases (61%) of shoulder dislocation involving the epiphysis. While in group B, there were seven (38%) cases with fracture metaphysis but not involving the epiphysis. Both groups were treated by closed or open reduction with or without internal fixation. All fractures healed in a mean of 7 weeks while the full function was achieved in an average of 21.58 weeks. Conclusion This systemic review supports the treatment of patients in group A by open reduction with K-wire fixation. While in group B, closed reduction with intramedullary fixation is a better option as it provides satisfactory clinical and radiological results in a short time.

Children's Mental Health in a Pandemic-Altered World: Technology's Evolving Role

Children's Mental Health in a Pandemic-Altered World: Technology's Evolving Role

On a global child protection fund financed by international tech companies

AbstractDespite admirable in‐house efforts of international tech corporations, the heavy burden of online well‐being is tacitly placed on the shoulders of children and their parents at the moment. In addition, end‐to‐end encryption has almost become an absolute tech industry standard and alternative technical methods to identify child abuse incidents within an end‐to‐end encryption scheme met with privacy concerns such as Apple’s recent attempt on implementing ‘client‐side scanning’ into their phones. As a result, the technical capabilities of such companies to handle online child safety issues will be diminished considerably, and the tech industry will rely on user reporting and metadata analysis more than ever. To complement the current and forthcoming technical measures taken by international tech companies, not to replace them, this article introduces the non‐technical concept of a global child protection fund. This fund would be financed by a small, fixed tax rate on the yearly net corporate earnings of these companies to support capacity‐building programs for online child sexual abuse worldwide, developing countries in particular. The global fund would be managed by UNICEF in close coordination with global and local stakeholders, and it would be proportionately distributed among the beneficiaries in line with the socio‐economic level and the national user base of each tech company. After a brief introduction to corporate social responsibility (CSR) and CSR tax, the article will elaborate on its proposed model with some base assumptions to make it easier for the readers to comprehend the conceptual aspects. Then, it will discuss which substantial challenges it could face in real life and speculate to what extent the ethical and practical foundations of this model could be applied to alleviate the global inequalities in other areas.

Physical Activity and Parameters of Body Posture in the Frontal Plane in Children

Abstract Introduction Physical activity may have an impact on the parameters of body posture. Scientific reports suggest that levels of physical activity are declining among society, which may result in incorrect changes in body posture. This study aimed to assess the relationship between physical activity and the parameters characterizing posture in the frontal plane in children. Material and Methods Sixty-seven primary school students aged 9 were enrolled in the study, including 29 girls and 38 boys. The posture was evaluated with the photogrammetric method. Also, anthropometric measures and the level of physical activity were investigated. Results The highest percentage of examined children was characterized by a moderate level of physical activity. Children with a high level of physical activity were characterized by the greater asymmetry of position between the right and left shoulder as compared to those with a low and a moderate level of physical activity. Conclusions There were statistically significant differences only in the height of shoulders in children with a high level of physical activity. This study should be repeated in adolescence, characterized by changes in development and a reluctance to physical activity.

Fracture-Subluxation of the Shoulder in Children

Glenohumeral dislocation in pediatric age is a rare injury. The proximal humerus fractures, on the other hand, are relatively common with the management ranging from conservative to operative fixation. Concomitant proximal humeral fracture and subluxation or dislocation of ipsilateral glenohumeral joint are the rarer events with very few reports available in the literature. We present a series of four pediatric cases (2 males and 2 females) of fracture dislocation of the shoulder with relevant details. All the cases suffered injuries following fall from tree and were managed by operative means in two while two were managed conservatively. Good functional outcome was noted in the mean follow-up of 10 months.

Pseudo paralysis of the shoulder and increased C-reactive protein are predictive factors for septic shoulder in children superior to other clinical symptoms: A retrospective case series of 25 patients

PurposeThe aim of the study was to evaluate predictable parameters with the highest sensitivity used in the diagnosis of children septic shoulder arthritis.MethodsAll children treated in our paediatric orthopaedic hospital between 2000 and 2017 with intraoperative verified septic arthritis of the shoulder were included in this retrospective study. Diagnostic procedures e.g. ultrasound, MRI, radiograph or blood samples as well as typical clinical symptoms were evaluated as predictable parameters for septic shoulder arthritis in paediatric patients. Descriptive statistics as well as sensitivity analysis were performed.ResultsIn all, 25 children, 20 boys and five girls, aged from eight days to 15 years, were included for further statistical analysis. All parameters included were tested for sensitivity with binomial confidence intervals (Cis) of 95%. Predictive parameters with highest sensitivity were pseudo paralysis (100%, CI 0.86 to 1.00) and C-reactive protein (CRP) (96%, CI 0.79 to 0.99) superior to temperature (52%, CI 0.3 to 0.73), white blood count (11%, CI 0.01 to 0.34), radiograph (21%, CI 0.04 to 0.50), ultrasound (71%, CI 0.47 to 0.88) or MRI (100%, CI 0.78 to 1.00).ConclusionThe diagnosis of a septic arthritis of the shoulder in children can be challenging for the clinician and especially for the resident doctor. Clinical symptoms such as pseudo paralysis and increased CRP level must be considered as predictive markers not to delay further diagnostics and treatment.Level of EvidenceIV

Assessment Of Active Shoulder Rotation After Tendon Transfer Around The Shoulder In Cases Of Residual Brachial Plexus Injury

Background: Active range of motion were analyzed as the outcomes of tendon transfer around the shoulder in children who had internal rotation contracture deformities secondary to obstetric brachial plexus palsy (OBPP) to improve the shoulder external rotation. Regarding to importance of external rotation there was some limitation of internal rotation which can affect patient’s daily activities. Methods: 50 patients with brachial plexus injury who underwent tendon transfer (teres major or latissimus dorsi) with or without anterior shoulder release in two separate incisions. Coracohumeral ligament release and Subscapularis release were done for all patients through anterior incision. A separate second incision in the posterior axillary fold was carried out to perform rerouting of the teres major or latissimus dorsi tendon. Results: The average active external rotation in abduction increased from 23.5o preoperatively to 76.4o postoperatively. The average active external rotation in adduction increased from 9.6o to 77.5o. The average shoulder abduction increased from 74.5o to 142.6o. Active internal rotation was analyzed just after operation, 6 month after and one year after. There was limited active IR in adduction from 10o to 50o with mean average 28.21o and improvement gradually with physiotherapy. Conclusions: Anterior shoulder release combined with latissimus dorsi or teres major rerouting significantly improved global shoulder function, but with limitations of active internal rotation which improving significally with physiotherapy.

Posterior artrolysis of the elbow, as a method of correction extensor contracturing of the elbow in children with arthrogryposis

Background. In children with arthrogryposis, a lack of elbow flexion with extensor elbow contractures limits the childs self-care.
 Aim. The aims of this study were to follow and analyze treatment results after posterior arthrolysis of the elbow joint with lengthening (Z-plasty, according to the V-Y technique) or without lengthening the triceps of the shoulder in children with arthrogryposis in different age groups.
 Materials and methods. Data from 109 patients with arthrogryposis with extensor contractures in the elbow joints (158 joints) who underwent posterior arthrolysis of the elbow joint to increase passive flexion in the elbow joint from 2005 to 2018 were included in this study. Clinical, and X-ray examination of patients was carried out.
 Results. The children were divided into nine groups depending on their age at the time of the operation and the method of surgical correction (with or without lengthening of the triceps muscle). The follow-up period in the postoperative period in the main group of patients (67.1% of cases) was 4.5 years. Good treatment results were observed in 95.83% of children younger than 3 years who did not lengthen the triceps compared with 85.56% of children of the same age who extended the triceps tendon. The amplitude of passive movements after surgery was greatest in children younger than 1 year and was greater with lengthening (104.00 16.24) than without lengthening (91.38 10.27) of the triceps tendon (p 0.001). However, in cases where lengthening of the triceps tendon was not performed, extension was less limited. Over 3 years, m. triceps br. showed satisfactory results with Z-extension and V-Y extension, increasing to 19.44% and 36.51%, respectively. Results of treatment in children older 7 than years were comparable with those of children 37 years old.
 Conclusions. In children with arthrogryposis after posterior arthrolysis of the elbow joint, receiving a passive range of motion in the elbow joint allowed the child to use adaptive mechanisms for self-care. The results of treatment with extensor elbow contracture after posterior artrolysis depended not on the elongation technique (V-Y or Z-plasty) but on the angle at which the triceps tendon was sewed, the patients age at the time the operation was performed, and the postsurgery rehabilitation of the child.

Outcome of Tendon Transfer Around Shoulder with Erb's Palsy Internal Rotation Deformity

AbstractBackground: Obstetric Brachial Plexus Palsy (OBPP) is one of the most severe complications at birth with internal rotation deformity that have significant functional disability. There is a many different methods of tendon transfer that have been descried to improve the shoulder Range of Motion (ROM).Aim of Study: Evaluate the outcome of teres major tendon transfer around the shoulder in children with Erb's palsy internal rotation deformity.Methods: This study was Retrospective and prospective randomized clinical study carried out on totally (25) patients admitted to Orthopaedic Department of Tanta University Hospital. Ten children represented the Retrospective portion of the study, and fifteen represented the prospective portion. All cases were operated by Modified Sever-L'Episcopo tech-nique. The external rotation, according to Mallet score, was recorded pre-and post-operatively.Results: The mean follow-up period was twelve months (range 6-18). The Mallet score for the shoulder external rotation, at the end of follow-up periods, was graded as Grade II in two patients (8%), Grade III in nine patients (36%), and Grade IV in fourteen patients (56%). There was a highly significant improvement (p=0.00001) of the external rotation range as the mean pre-operative score was 2.04±0.02, and the mean post-operative score was 3.48±0.65.Conclusion: The Modified Sever L'Episcopo procedure that compromises of anterior release, then teres major tendon transfer to the tendon of infraspinatus shows a high incidence of good outcome with a promising subjective and objective improvement in almost cases.

Evolution of postural alignment in preschool and school phases: A longitudinal study

Abstract Aim: To identify postural variations in the positioning of the head, cervical spine and shoulders of children in two phases - preschool and school. Methods: This was a longitudinal study, a convenience sample with 99 children of both genders, in preschool (5-6 years old) and school (8-11 years old) phases. The postural alignment of the head, cervical spine and shoulders was evaluated through computerized photogrammetry and analyzed by SAPo software. Results: Differences were found between preschool and school phases, but only the variables of shoulder angle (SA) and forward head distance (FHD) were significantly different (SA = 32.79 [30.49 - 35.09] and 35.84 [33.53 - 38.15] p = 0.026, respectively; FHD = 8.40 [8.07 - 8.73] and 11.23 [10.94-11.52] p <0.001, respectively). A positive correlation was obtained between forward head distance and body mass (rho= 0.597, p <0.001). Conclusion: There are changes in head and shoulder alignment between preschool and school phases, with protrusion of shoulders and forward head distance findings in children who have evolved their posture. Therefore, parents should be aware of children’s posture, and health and education professionals should be involved in screening and prevention programs.

Osteomyelitis is Commonly Associated With Septic Arthritis of the Shoulder in Children.

To describe the clinical presentation, management, and outcomes of surgically treated septic arthritis of the shoulder in a pediatric population. A retrospective chart review over 5 years of children with operatively managed septic arthritis of the shoulder was completed. Demographics, clinical presentation, symptoms duration, antibiotic regimen and duration, number of surgical procedures, and evaluation of laboratory value improvements were collected. Pretreatment and final radiographs were assessed. Causative organisms were reviewed. Patients were stratified in age groups to determine clinical variability based upon patient age. A total of 22 children, ages 15 days to 14 years (average 37.3 mo), were treated for septic arthritis of the shoulder from 2006 to 2010 at a single pediatric institution. All patients were managed with open anterior arthrotomy at an average of 1.95 days after initial orthopaedic consultation (range, 0 to 15 d). Multiple presenting signs were noted; the most common was decreased use (59%). Average admission laboratory values include C-reactive protein 10.6 (range, 0.3 to 41.6), erythrocyte sedimentation rate 62.8 (range, 11 to 107), and white blood cell count 14.9 (range, 5.9 to 31.7). Initial radiographs were read as normal in 12 patients, concern for osteomyelitis in 5, cortical irregularity in 4, effusion in 3, and neoplasm in a single child. Nineteen patients had a preoperative magnetic resonance imaging and 15 demonstrated an effusion, 15 had evidence of humeral osteomyelitis, 5 had a subperisoteal abscess, and 4 had soft tissue abscesses. Eight patients remained culture negative. The most commonly identified organism was methcillin-resistant Staphylococcus aureus (MRSA) (22.7%). The patients under 12 months of age revealed more diverse organisms at culture and were less likely to have MRSA. All patients averaged 1.55 (range, 1 to 5) surgical procedures and had an average hospital stay of 13.5 days. Intravenous antibiotics averaged 16.3 days followed by an average of 34 days of oral treatment. MRSA patients were significantly more likely to require multiple operations to eradicate the infection (P<0.02) and had a longer duration of intravenous antibiotic use (P<0.003). MRSA patients were more likely to have abnormal radiographs at final follow-up (P<0.03). Septic arthritis of the shoulder in children is commonly associated with adjacent osteomyelitis. Pediatric septic arthritis of the shoulder due to MRSA bacteria can have a more virulent course than other bacterial causes, but is a less commonly identified organism in the youngest patients. To our knowledge, this is one of the largest series published concerning the treatment, course, and outcomes of pediatric septic arthritis of the shoulder. Level III-therapeutic.

Strategies for the Abnormal Co-Contraction of Internal Rotators of the Shoulder in Children with Obstetrical Brachial Plexus Palsy

Dear Editor, Obstetrical brachial plexus palsy (OBPP) is caused by traction of the brachial plexus during delivery. The incidence of OBPP was once reported to be 2.9 per 1000 live births, and the incidence of persisting OBPP was 0.46 per 1000. 1 Although most patients with OBPP recover spontaneously in the first 2 months, up to 35% are left with varying degrees of shoulder weakness, contracture, or joint deformity. 2 Even after neuro-reconstructive surgery, children with incomplete recovery often have abnormal motor performance. 3

An MRI study on the relations between muscle atrophy, shoulder function and glenohumeral deformity in shoulders of children with obstetric brachial plexus injury

An MRI study on the relations between muscle atrophy, shoulder function and glenohumeral deformity in shoulders of children with obstetric brachial plexus injury

An MRI study on the relations between muscle atrophy, shoulder function and glenohumeral deformity in shoulders of children with obstetric brachial plexus injury

BackgroundA substantial number of children with an obstetric brachial plexus lesion (OBPL) will develop internal rotation adduction contractures of the shoulder, posterior humeral head subluxations and glenohumeral deformities. Their active shoulder function is generally limited and a recent study showed that their shoulder muscles were atrophic. This study focuses on the role of shoulder muscles in glenohumeral deformation and function.MethodsThis is a prospective study on 24 children with unilateral OBPL, who had internal rotation contractures of the shoulder (mean age 3.3 years, range 14.7 months to 7.3 years). Using MR imaging from both shoulders the following parameters were assessed: glenoid form, glenoscapular angle, subluxation of the humeral head, thickness and segmental volume of the subscapularis, infraspinatus and deltoid muscles. Shoulder function was assessed measuring passive external rotation of the shoulder and using the Mallet score for active function. Statistical tests used are t-tests, Spearman's rho, Pearsons r and logistic regression.ResultsThe affected shoulders showed significantly reduced muscle sizes, increased glenoid retroversion and posterior subluxation. Mean muscle size compared to the normal side was: subscapularis 51%, infraspinatus 61% and deltoid 76%. Glenoid form was related to infraspinatus muscle atrophy. Subluxation was related to both infraspinatus and subscapularis atrophy. There was no relation between atrophy of muscles and passive external rotation. Muscle atrophy was not related to the Mallet score or its dimensions.ConclusionMuscle atrophy was more severe in the subscapularis muscle than in infraspinatus and deltoid. As the muscle ratios are not related to passive external rotation nor to active function of the shoulder, there must be other muscle properties influencing shoulder function.

Pseudo-anévrisme de l’artère axillaire secondaire à une luxation de l’épaule chez l’enfant

Axillary artery injury following anterior dislocation of the shoulder in children is a rare complication often considered as iatrogenic. We report the case of a pseudo-aneurysm of the axillary artery in a 5-year-old boy that appeared four months after a shoulder dislocation that was reduced in an ambulatory setting. Although this is an uncommon vascular complication, we emphasize the need for short-term and long-term follow-up in these children to avoid missing a pseudo-aneurysm of the axillary artery.

Diagnostic performance of magnetic resonance arthrography of the shoulder in children

No reported data demonstrate the usefulness of magnetic resonance arthrography of the shoulder in children. To evaluate the sensitivity, specificity and accuracy of MR arthrography in the assessment of superior labral anteroposterior (SLAP) tears of the shoulder, Bankart-type injuries and Hill-Sachs lesions in children as compared to arthroscopy. We retrospectively interpreted 66 MR arthrograms of the shoulder and compared them with surgical findings. Assessment included evaluation of the osseous structures, labral-ligamentous complex and determination of skeletal maturity. We calculated sensitivity, specificity and accuracy and compared sensitivity and specificity between skeletally mature and immature children. MR arthrography demonstrated a sensitivity, specificity and accuracy of 88%, 98% and 94%, respectively, for depiction of SLAP tears; 94%, 92% and 94% for detection of Bankart-type injuries; and 100%, 94% and 97% for diagnosing Hill-Sachs lesions. There was no statistical difference between the skeletally immature and skeletally mature groups. There is no significant difference in the diagnostic accuracy of MR arthrography in skeletally immature versus skeletally mature children. MR shoulder arthrography is an effective method for the detection of labral and bone pathology.

小児の肩関節多方向不安定症に起因する非外傷性(亜)脱臼に対するmanagementについて

小児の肩関節多方向不安定症に起因する非外傷性(亜)脱臼に対するmanagementについて

Shoulder Arthrodesis for Treatment of Flail Shoulder in Children With Polio

Poliomyelitis in children can cause paralysis of shoulder girdle muscles leading to a flail shoulder. Shoulder arthrodesis is indicated as a possible treatment for these children in order to stabilize the shoulder. This retrospective study reviewed all shoulder arthrodesis surgeries owing to complications of polio performed at a major medical institution between 1981 and 1996 to assess position of fusion, radiographic evidence of fusion, complications, and patient satisfaction. A review of medical records identified 11 patients undergoing 13 shoulder arthrodesis procedures, with a mean age of 14.7 years at the time of the procedure. Internal fixation was achieved with large cancellous screws in 8 patients and a Dynamic Compression Plate (DCP) plate in 5 procedures. Average follow-up period was 41 months. Eight patients were placed into a spica cast and 5 used a sling postoperatively. Shoulder arthrodesis surgery in this cohort resulted in an average position of fusion with 42.3 degrees of abduction, 23.8 degrees of flexion, and 26.2 degrees of internal rotation. Twelve of the 13 procedures assessed for radiographic union demonstrated fusion. The most common complications were malrotation and nonunion. Of the 13 procedures, 2 underwent humeral osteotomies for malrotation, and 1 with 6.5 mm cancellous screws required revision with a DCP plate owing to nonunion. Six patients underwent hardware removal, 3 of which were specifically owing to complaints of painful hardware. At final follow-up, no patient reported pain and all expressed satisfaction with their results and improved shoulder function after repair. This study is the largest series of shoulder arthrodesis surgeries for treatment of patients with a flail shoulder from polio to date, providing a more thorough analysis of its efficacy as an indicated treatment. Level III-Retrospective Comparative Study.

Magnetic Resonance Imaging and Clinical Findings Before and After Tendon Transfers About the Shoulder in Children With Residual Brachial Plexus Birth Palsy: A 3-year Follow-up Study

Incomplete recovery after brachial plexus birth palsy often results in decreased movement and muscle imbalance about the shoulder, as rotator cuff and deltoid innervation are incomplete. Tendon transfers redistribute the forces about the joint and were thought to promote glenohumeral joint remodeling. Early reports, however, indicate limited ability to affect joint configuration. Our previous report and conclusions to this regard were based upon short follow-up. The purpose of this study was to assess the magnetic resonance imaging and clinical outcome after tendon transfers about the shoulder in children with residual brachial plexus birth palsy. This was a retrospective chart review of 24 children who underwent transfer of the latissimus dorsi and teres major to the posterior rotator cuff with or without concomitant musculotendinous lengthenings. Follow-up magnetic resonance imaging data were available for all subjects at 1-year postsurgery and 19 subjects at 3-year follow-up. Preoperative average glenoid version was -25+/-13 degrees (range, -51- -11 degrees). Compared with preoperative version, there was no statistical difference at 1 year (-25+/-14 degrees; range, -56- -7 degrees; P=1.00) or at 3 years (-22+/-11 degrees; range, -54- -8 degrees; P=1.00). Preoperative average percent of humeral head anterior was 29%+/-15% (range, 0%-44%). Compared with preoperative percent of humeral head anterior, there was no statistical difference at 1 year (28%+/-16%; range, 0%-52%; P=1.00) or at 3 years (35%+/-13%; range, 0%-51%; P=0.32). Clinical evaluation showed significant improvements (P<0.05) in preoperative (-3+/-21) to 1-year (18+/-32) external rotation Significant improvements in abduction were found from 116+/-39 degrees before surgery to 151+/-30 degrees and 161+/-20 degrees at 1 and 3 years after surgery, respectively. These results demonstrate that tendon transfers improve overall shoulder motion, but do not reduce humeral head subluxation or improve glenohumeral joint realignment. Level IV.