Arthroscopic versus open release of internal rotation contracture in the obstetrical brachial plexus paralysis (OBPP) sequela

J Shoulder Elbow Surg. 2019 Jan;28(1):28-35. doi: 10.1016/j.jse.2018.06.020. Epub 2018 Sep 6.

Abstract

Background: Latissimus dorsi (LD) and teres major (TM) tendon transfers are effective surgical procedures to improve shoulder abduction and external rotation for children with obstetrical brachial plexus palsy (OBPP). Open pectoralis major (PM) tendon Z-plasty and arthroscopic subscapularis (SS) release are 2 options for the release of internal rotation contractures to enhance muscle transfers. This study compared the functional results of LD and TM tendon transfers with open PM tendon Z-plasty or arthroscopic SS release.

Methods: The study included 24 patients who underwent LD and TM tendon transfers for OBPP (9 arthroscopic SS release, 15 open PM tendon Z-plasty) with a mean follow-up of 41.33 months (range, 36-60 months) and 47.2 months (range, 36-60 months), respectively. Functional evaluation was made according to range of motion and Mallet scoring system.

Results: Shoulder abduction-external rotation degrees and scores in all sections of the Mallet scoring system significantly increased in both groups (P < .001). Postoperatively, the arthroscopic SS release group had significantly better abduction degrees (P = .003), total Mallet scores (P < .001), and superior abduction (P = .043), active external rotation (P = .043), hand-to-head (P = .043), and hand-to-mouth (P < .001) scores for the Mallet scoring system.

Discussion: Transfer of LD together with TM tendons combined with one of the internal rotation contracture release procedures yielded good clinical and functional results in patients younger than age 7, regardless of the type of release method. However, arthroscopic SS release, although requiring an experienced surgeon, revealed better clinical and functional outcomes and is considered to be a less invasive and superior method.

Keywords: Mallet score; Obstetrical brachial plexus palsy; arthroscopic SS release; internal rotation contracture; latissimus dorsi and pectoralis major tendon transfers; open pectoralis major tendon Z-plasty; release procedures.

MeSH terms

  • Arthroscopy / methods*
  • Child, Preschool
  • Disease Progression
  • Female
  • Humans
  • Male
  • Neonatal Brachial Plexus Palsy / physiopathology
  • Neonatal Brachial Plexus Palsy / surgery*
  • Range of Motion, Articular / physiology
  • Shoulder Joint / physiopathology
  • Shoulder Joint / surgery*
  • Tendon Transfer / methods*
  • Treatment Outcome