Acta Orthop Traumatol Turc
Treatment of residual obstetrical brachial plexus palsy with tendon transfer
Abstract
Objectives: We evaluated the results of the correction of adduction and internal rotation deformities of the shoulder associated with residual obstetrical brachial plexus palsy (OBPP) by the transfer of latissimus dorsi and teres major muscles to the rotator cuff.
Methods: In order to correct adduction and internal rotation deformities associated with residual OBPP, 10 patients (7 males, 3 females; mean age 8.1 years; range 4 to 19 years) underwent transfer of the latissimus dorsi and teres major muscles to the rotator cuff and lengthening of the pectoralis major tendon with Z-plasty. The right and left extremities were affected in seven and three patients, respectively. Involvement of the C5-C6 nerve roots was detected in four, and C5-C6-C7 nerve roots in six patients. In two patients with a positive Putti sign, axillary roentgenograms showed posterior subluxation of the humeral head, and magnetic resonance and computed tomography scans revealed type III glenohumeral deformity. Functional evaluations were made using a 5-point scoring system proposed by Mallet. The mean follow-up was 23.6 months (5 to 42 months).
Results: Postoperatively, the mean abduction and external rotation were 134.5° (range 95° to 170°) and 70° (range 45° to 90°), respectively. The mean global abduction score was 4, external rotation score was 4.2, and the scores assigned to the ability to move hand to the neck and mouth were 3.5. Of two patients with type III glenohumeral deformity, whose ages were four and 19 years, abduction and external rotation were 150° and 45° in the former, 135° and 70° in the latter, respectively.
Conclusion: The transfer of the latissimus dorsi and teres major tendons is a necessary procedure to restore external rotation and abduction functions of paralysed shoulders. Compared to other techniques employed, it offers obvious advantages in terms of ease and cost, as well.
Methods: In order to correct adduction and internal rotation deformities associated with residual OBPP, 10 patients (7 males, 3 females; mean age 8.1 years; range 4 to 19 years) underwent transfer of the latissimus dorsi and teres major muscles to the rotator cuff and lengthening of the pectoralis major tendon with Z-plasty. The right and left extremities were affected in seven and three patients, respectively. Involvement of the C5-C6 nerve roots was detected in four, and C5-C6-C7 nerve roots in six patients. In two patients with a positive Putti sign, axillary roentgenograms showed posterior subluxation of the humeral head, and magnetic resonance and computed tomography scans revealed type III glenohumeral deformity. Functional evaluations were made using a 5-point scoring system proposed by Mallet. The mean follow-up was 23.6 months (5 to 42 months).
Results: Postoperatively, the mean abduction and external rotation were 134.5° (range 95° to 170°) and 70° (range 45° to 90°), respectively. The mean global abduction score was 4, external rotation score was 4.2, and the scores assigned to the ability to move hand to the neck and mouth were 3.5. Of two patients with type III glenohumeral deformity, whose ages were four and 19 years, abduction and external rotation were 150° and 45° in the former, 135° and 70° in the latter, respectively.
Conclusion: The transfer of the latissimus dorsi and teres major tendons is a necessary procedure to restore external rotation and abduction functions of paralysed shoulders. Compared to other techniques employed, it offers obvious advantages in terms of ease and cost, as well.