Shoulder Reconstruction in Obstetric Brachial Plexus Palsy in Older Children Via a One-Stage Release and Tendon Transfers

Shoulder deformity and contracture is a common finding after brachial plexus birth palsy even in those who have had good recovery of nerve function or have had micro surgical nerve repair at infancy. We would like to report our results with the reconstructive shoulder surgery in a group of older children. Shoulder contracture from brachial plexus birth palsy was surgically released in 24 older children with simultaneous transfer of the latissimus dorsi and teres major tendons to the posterolateral humerus or rotator cuff. The mean age at surgery was 8 years 11 months. The children were evaluated at a mean follow-up time of 6 years 8 months by the Modified American Shoulder and Elbow Surgeons Form and Shoulder Pain and Disability Index standardized shoulder assessment forms a questionnaire assessing activities of daily living and parent and patient satisfaction scales. The fixed internal rotation deformity of 30º±12º improved to 72.5º±27º of external rotation. Improvements of 65º±26º and 47º±33º were seen in abduction and forward elevation respectively all without preoperative casting or manipulation. Increased external rotation had a more positive correlation with a higher functional score than abduction. Patients with lower preoperative functional scores had more rotational gain and higher functional scores after surgery. Those aged over 9 years had a functional gain similar to that of the younger children. Simultaneous release of contracted shoulder and transfer of latissimus dorsi and teres major tendons in brachial plexus birth paralysis is effective and rewarding even in older children who have had late referral and might have already developed glenoid dysplasia.