Skip to main content
SpringerLink
Log in

Arthroscopic treatment for internal contracture of the shoulder secondary to brachial plexus birth palsy: report of a case series and review of the literature

  • Original Article • LOWER LIMB - TRAUMA
  • Published:
European Journal of Orthopaedic Surgery & Traumatology Aims and scope Submit manuscript

Abstract

Objectives

Internal rotation contracture of the shoulder is a common complication in children with brachial plexus birth palsy (BPBP), causing early functional limitation and glenohumeral dysplasia. Arthroscopic arthrolysis has recently been described as a treatment for the sequelae of this condition.

Methods

Review of five patients who underwent shoulder arthroscopy by anterior capsulotomy and partial tenotomy of the subscapularis. Both clinical and functional assessments were made (Mallet classification). Perioperative monitoring was conducted using MRI and ultrasound.

Results

The diagnosis was BPBP of the upper trunks (C5–C6) in all five patients (four girls and one boy, with a mean age of 2.8 years). The mean follow-up period was 19.9 months (range 12.8–39.9). The mean improvement obtained was 3.8 points according to the Mallet classification, 48° of external rotation and 54° of shoulder abduction.

Conclusions

Arthroscopic arthrolysis of the shoulder in children with BPBP sequelae (internal rotation contractures) is a safe and effective procedure that produces clinical improvement in function and mobility.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7
Fig. 8

Similar content being viewed by others

References

  1. Abzug JM, Kozin SH (2010) Current concepts: neonatal brachial plexus palsy. Orthopedics 33(6):430–435. doi:10.3928/01477447-20100429-25

    Article  PubMed  Google Scholar 

  2. Jellicoe P, Parsons SJ (2008) Brachial plexus birth palsy. Curr Orthop 4:289–294

    Article  Google Scholar 

  3. Soldado F, Fontecha CG, Marotta M, Benito D, Casaccia M, Mascarenhas VV, Zlotolow D, Kozin SH (2014) The role of muscle imbalance in the pathogenesis of shoulder contracture after neonatal brachial plexus palsy: a study in a rat model. J Shoulder Elbow Surg 23(7):1003–1009. doi:10.1016/j.jse.2013.09.031

    Article  PubMed  Google Scholar 

  4. Ruchelsman DE, Grossman JA, Price AE (2011) Glenohumeral deformity in children with brachial plexus birth injuries. Bull NYU Hosp Jt Dis 69(1):36–43

    PubMed  Google Scholar 

  5. Terzis JK, Vekris MD, Okajima S, Soucacos PN (2003) Shoulder deformities in obstetric brachial plexus paralysis: a computed tomography study. J Pediatr Orthop 23(2):254–260

    PubMed  Google Scholar 

  6. Hale HB, Bae DS, Waters PM (2010) Current concepts in the management of brachial plexus birth palsy. J Hand Surg Am 35(2):322–331. doi:10.1016/j.jhsa.2009.11.026

    Article  PubMed  Google Scholar 

  7. Waters PM, Monica JT, Earp BE, Zurakowski D, Bae DS (2009) Correlation of radiographic muscle cross-sectional area with glenohumeral deformity in children with brachial plexus birth palsy. J Bone Joint Surg Am 91(10):2367–2375. doi:10.2106/JBJS.H.00417

    Article  PubMed  Google Scholar 

  8. Pearl ML (2003) Arthroscopic release of shoulder contracture secondary to birth palsy: an early report on findings and surgical technique. Arthroscopy 19(6):577–582

    Article  PubMed  Google Scholar 

  9. Vathana T, Rust S, Mills J, Wilkes D, Browne R, Carter PR, Ezaki M (2007) Intraobserver and interobserver reliability of two ultrasound measures of humeral head position in infants with neonatal brachial plexus palsy. J Bone Joint Surg Am 89(8):1710–1715. doi:10.2106/JBJS.F.01263

    Article  PubMed  Google Scholar 

  10. Mallet J (1972) Obstetrical paralysis of the brachial plexus. II. Therapeutics. Treatment of sequelae. Priority for the treatment of the shoulder. Method for the expression of results. Rev Chir Orthop Reparatrice Appar Mot 58(Suppl 1):166–168

    PubMed  Google Scholar 

  11. Abzug JM, Chafetz RS, Gaughan JP, Ashworth S, Kozin SH (2010) Shoulder function after medial approach and derotational humeral osteotomy in patients with brachial plexus birth palsy. J Pediatr Orthop 30(5):469–474. doi:10.1097/BPO.0b013e3181df8604

    Article  PubMed  Google Scholar 

  12. Clarke HM, Curtis CG (1995) An approach to obstetrical brachial plexus injuries. Hand Clin 11(4):563–580 (discussion 580–561)

    CAS  PubMed  Google Scholar 

  13. Pearl ML (2009) Shoulder problems in children with brachial plexus birth palsy: evaluation and management. J Am Acad Orthop Surg 17(4):242–254

    PubMed  Google Scholar 

  14. Arad E, Stephens D, Curtis CG, Clarke HM (2013) Botulinum toxin for the treatment of motor imbalance in obstetrical brachial plexus palsy. Plast Reconstr Surg 131(6):1307–1315. doi:10.1097/PRS.0b013e31828bd487

    Article  CAS  PubMed  Google Scholar 

  15. Bennett JB, Allan CH (2000) Tendon transfers about the shoulder and elbow in obstetrical brachial plexus palsy. Instr Course Lect 49:319–332

    CAS  PubMed  Google Scholar 

  16. Midha R (2004) Nerve transfers for severe brachial plexus injuries: a review. Neurosurg Focus 16(5):E5

    Article  PubMed  Google Scholar 

  17. Pedowitz DI, Gibson B, Williams GR, Kozin SH (2007) Arthroscopic treatment of posterior glenohumeral joint subluxation resulting from brachial plexus birth palsy. J Shoulder Elbow Surg 16(1):6–13. doi:10.1016/j.jse.2006.04.008

    Article  PubMed  Google Scholar 

  18. Abid A, Kany J, Accadbled F, Darodes P, Knorr G, de Gauzy JS, Cahuzac JP (2008) Arthroscopic anterior capsular release in medial contracture of the shoulder secondary to brachial plexus birth palsy. Preliminary results. Rev Chir Orthop Reparatrice Appar Mot 94(7):643–648. doi:10.1016/j.rco.2008.01.003

    Article  CAS  PubMed  Google Scholar 

  19. Kozin SH, Boardman MJ, Chafetz RS, Williams GR, Hanlon A (2010) Arthroscopic treatment of internal rotation contracture and glenohumeral dysplasia in children with brachial plexus birth palsy. J Shoulder Elbow Surg 19(1):102–110. doi:10.1016/j.jse.2009.05.011

    Article  PubMed  Google Scholar 

  20. Mehlman CT, DeVoe WB, Lippert WC, Michaud LJ, Allgier AJ, Foad SL (2011) Arthroscopically assisted Sever-L’Episcopo procedure improves clinical and radiographic outcomes in neonatal brachial plexus palsy patients. J Pediatr Orthop 31(3):341–351. doi:10.1097/BPO.0b013e31820cada8

    Article  PubMed  Google Scholar 

  21. Breton A, Mainard L, De Gasperi M, Barbary S, Maurice E, Dautel G (2012) Arthroscopic release of shoulder contracture secondary to obstetric brachial plexus palsy: retrospective study of 18 children with an average follow-up of 4.5 years. Orthop Traumatol Surg Res 98(6):638–644. doi:10.1016/j.otsr.2012.06.013

    Article  CAS  PubMed  Google Scholar 

  22. Kany J, Kumar HA, Amaravathi RS, Abid A, Accabled F, de Gauzy JS, Cahuzac JP (2012) A subscapularis-preserving arthroscopic release of capsule in the treatment of internal rotation contracture of shoulder in Erb’s palsy (SPARC procedure). J Pediatr Orthop B 21(5):469–473. doi:10.1097/BPB.0b013e328353a19f

    Article  PubMed  Google Scholar 

  23. Kokkalis ZT, Ballas EG, Mavrogenis AF (2013) Arthroscopic release of shoulder internal rotation contracture in children with brachial plexus birth palsy. Acta Orthop Belg 79(4):355–360

    PubMed  Google Scholar 

  24. Pearl ML, Edgerton BW, Kazimiroff PA, Burchette RJ, Wong K (2006) Arthroscopic release and latissimus dorsi transfer for shoulder internal rotation contractures and glenohumeral deformity secondary to brachial plexus birth palsy. J Bone Joint Surg Am 88(3):564–574. doi:10.2106/JBJS.D.02872

    Article  PubMed  Google Scholar 

  25. Pandya NK, Namdari S (2013) Shoulder arthroscopy in children and adolescents. J Am Acad Orthop Surg 21(7):389–397. doi:10.5435/JAAOS-21-07-389

    Article  PubMed  Google Scholar 

  26. Siparsky PN, Kocher MS (2009) Current concepts in pediatric and adolescent arthroscopy. Arthroscopy 25(12):1453–1469. doi:10.1016/j.arthro.2009.03.011

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

The authors thank the Research and Development Department of the Hospital Costa del Sol for their language review of this manuscript.

Author information

Authors and Affiliations

  1. Department of Orthopaedics and Traumatology, Hospital Costa Del Sol, University of Málaga, Autovia A7 km 187, 29603, Marbella, Málaga, Spain

    Pablo Andrés-Cano

  2. Department of Orthopaedics and Traumatology, Hospital Virgen del Rocío, University of Sevilla, Avenida Manuel Siurot, s/n, 41013, Seville, Spain

    Miguel Ángel Toledo, David Michael Farrington & Juan José Gil

Authors
  1. Pablo Andrés-Cano
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Miguel Ángel Toledo
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. David Michael Farrington
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Juan José Gil
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Pablo Andrés-Cano.

Ethics declarations

Conflict of interest

The authors declare that there are no conflicts of interest.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Andrés-Cano, P., Toledo, M.Á., Farrington, D.M. et al. Arthroscopic treatment for internal contracture of the shoulder secondary to brachial plexus birth palsy: report of a case series and review of the literature. Eur J Orthop Surg Traumatol 25, 1121–1129 (2015). https://doi.org/10.1007/s00590-015-1670-x

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00590-015-1670-x

Keywords

Search

Navigation