Skip to main content
SpringerLink
Log in

Adduction contracture of the shoulder due to fibrous long head of the triceps in children

  • Original Clinical Article
  • Published:
Journal of Children's Orthopaedics

Abstract

Objective

To evaluate the clinical and functional results of surgical treatment for fibrous long head of the triceps in children.

Materials and methods

Data were analyzed from 32 patients (38 shoulders) aged over 5 years of age from August 1995 to December 2004. The adduction contracture, elbow flexed angles when the scapula was held in the chest wall, and scapulo-humeral angles in radiographs were measured. Surgical release of the long head of the triceps was performed.

Results

There were 22 females and 10 males in this study. Bilateral shoulder involvement was found in six patients. Only the right shoulder was involved in 5 patients, and only the left in 21 patients. All 32 patients (38 shoulders) developed adduction contracture of the shoulder after repeated intramuscular injection of antibiotic(s) into the long head of the triceps. Thirty-four shoulders (29 patients) were classified as severe, and four shoulders (3 patients) were classified as moderate. In all, we attained excellent results in 36 shoulders (94.7%) and good results in two shoulders (5.3%). There have been no fair or poor results or complications so far.

Conclusion

Generally, surgical treatment of adduction contracture of the shoulder has achieved good results, with improved shoulder function. Releasing the long head of the triceps is a simple and safe surgical technique.

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

Similar content being viewed by others

References

  1. Babhulkar SS (1985) Triceps contracture caused by injections. A report of 11 cases. J Bone Joint Surg Br 67(1):94–96

    CAS  Google Scholar 

  2. Burnei G, Neagoe P, Margineanu BA, Dan DD, Bucur PO (2004) Treatment of severe iatrogenic quadriceps retraction in children. J Pediatr Orthop B 13(4):254–258. doi:10.1097/01.bpb.0000111028.02081.2e

    Article  Google Scholar 

  3. Cozen LN (1977) Pentazocine injections as a causative factor in dislocation of the shoulder. A case report. J. Bone Joint Surg Am 59:979

    CAS  Google Scholar 

  4. Fukushima T, Takasago S, Nakamura G, Kobayashi T (1966) Surgery and histological findings in contracture of the rectus femoris muscle (in Japanese). Seikei Geka 17(5):403–406

    Google Scholar 

  5. Hang YS (1979) Contracture of the hip secondary to fibrosis of the gluteus maximus muscle. J. Bone and Joint Surg Am 61:152–155

    Google Scholar 

  6. Justis EJ (1980) Muscle contractures. In: Allens E, Crenshaw AH (eds) Campbell’s operative orthopaedics. CV Mosby, St. Louis, MO, pp 2383–2385

    Google Scholar 

  7. Foad SL, Mehlman CT, Ying J (2008) The epidemiology of neonatal brachial plexus palsy in the United States. J Bone Joint Surg Am 90:1258–1264. doi:10.2106/JBJS.G.00853

    Article  Google Scholar 

  8. Beaton DE, Wright JG, Katz JN, Upper Extremity Collaborative Group (2005) Development of the QuickDASH: comparison of three item-reduction approaches. J Bone Joint Surg Am 87(5):1038–1046. doi:10.2106/JBJS.D.02060

    Article  Google Scholar 

  9. Dorcas EB, James GW, Jeffrey NK (2005) Development of the QuickDASH: comparison of three item-reduction approaches. J Bone Joint Surg Am 87:1038–1046

    Article  Google Scholar 

  10. Nguyen NH (2007) Fibrous deltoid muscle in vietnamese children. J Pediatr Orthop B 16(5):337–344

    Article  Google Scholar 

  11. Zimmermann R, Gschwentner M, Arora R et al (2003) Treatment of distal radioulnar joint disorders with a modified Sauve-Kapandji procedure: long-term outcome with special attention to the DASH questionnaire. Arch Orthop Trauma Surg 123(6):293–298. doi:10.1007/s00402-003-0529-5

    Article  Google Scholar 

  12. Henry AK (1957) The upper limb and neck. In: Henry AK (ed) Extensile exposures, 2nd edn. Williams & Wilkins Co, Baltimore, p 15

    Google Scholar 

  13. Hněvkovský O (1961) Progressive fibrosis of the vastus intermedius muscle in children. A cause of limited knee flexion and elevation of the knee. J Bone Joint Surg Br 43(2):318–325

    Google Scholar 

  14. Alvarez EV, Munters M, Lavine LS, Manes H, Waxman J (1980) Quadriceps myofibrosis. A complication of intramuscular injections. J Bone Joint Surg Am 62(1):58–60

    CAS  Google Scholar 

  15. Bhattacharyya SS (1966) Abduction contracture of the shoulder from contracture of the intermediate part of the deltoid. Report of three cases. J Bone Joint Surg Br 48(1):127–131

    CAS  Google Scholar 

  16. Branick RL, Roberts JL, Glynn JJ, Beatie JC (1976) Talwin induced deltoid contractures. In: Proceedings of the Western Orthopedic Association. J Bone Joint Surg Am 58; 279–286

  17. Chatterjee P, Gupta SK (1983) Deltoid contracture in children of central Calcutta. J Pediatr Orthop 3:380–383

    Article  CAS  Google Scholar 

  18. Frasch W, Saule H (1976) Casuistic contribution to acquired extension contracture in childhood (in German). Klin Padiatr 188(6):563–566

    CAS  Google Scholar 

  19. Gammie WFP, Taylor JH, Urich H (1963) Contracture of the vastus intermedius in children. J Bone Joint Surg Br 45:370–375

    Google Scholar 

  20. Warwick R, Williams PL (eds) (1973) Gray’s Anatomy. Longman Group, Edinburgh, pp 541–542

    Google Scholar 

  21. Gunn DR (1964) Contracture of the quadriceps muscle. A discussion on the etiology and relationship to recurrent dislocation of the patella. J Bone Joint Surg Br 46:492–497

    CAS  Google Scholar 

  22. Ko JY, An KN, Yamamoto R (1998) Contracture of the deltoid muscle. Results of distal release. J Bone Joint Surg Am 80(2):229–238

    CAS  Google Scholar 

  23. Lénárt G, Kullmann L (1974) Isolated contracture of the rectus femoris muscle. Clin Orthop Relat Res (99):125–130

  24. McCloskey JR, Chung MK (1977) Quadriceps contracture as a result of multiple intramuscular injection. Am J Dis Child 131(4):416–417

    CAS  Google Scholar 

  25. Milcan A, Eskandari MM, Oztuna V, Colak M, Kuyurtar F (2004) Injection-induced contracture of the quadriceps femoris muscle in children. Orthopedics 27(1):65–66

    Google Scholar 

  26. Minami M, Yamazaki J, Minami A, Ishii S (1984) A postoperative long-term study of the deltoid contracture in children. J Pediatr Orthop 4:609–613

    Article  CAS  Google Scholar 

  27. Mukherjee PK, Das AK (1980) Injection fibrosis in the quadriceps femoris muscle in children. J Bone Joint Surg Am 62(3):453–456

    CAS  Google Scholar 

  28. Hung NN (2008) Using an Iliotibial tract for patellar dislocation in children. J Child Orthop 2(5):343–351

    Article  Google Scholar 

  29. Sharrard WJW (1979) Developmental contracture of the quadripceps. In: Sharrard WJW (ed) Paediatric orthopaedics and fracture. Blackwell, Oxford, pp 877–880

    Google Scholar 

  30. Sun X (1990) An investigation on injectional gluteal muscle contracture in childhood in Mianyang City. Zhonghua Liu Xing Bing Xue Zhi 11(5):291–294

    CAS  Google Scholar 

  31. Tang X, Liu L, Pen M, Yu Y, Li J (2006) Diagnosis and treatment of deltoid contracture in children (in Chinese). Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi 20:279–281

    Google Scholar 

  32. Valdiserri L, Andrisano A, Manfrini M, Mazzetti M, Porcellini G (1989) Post-injective quadriceps contracture. Ital J Orthop Traumatol 15(3):267–272

    CAS  Google Scholar 

  33. Vetter WL, Weiland AJ, Arnett FC (1983) Factitious extension contracture of the elbow: case report. J Hand Surg Am 8(3):277–279

    Article  CAS  Google Scholar 

  34. Ko JY, An KN, Yamamoto R (1998) Contracture of the deltoid muscle. Results of distal release. J Bone Joint Surg Am 80:229–238

    CAS  Google Scholar 

  35. Wolbrink AJ, Hsu Z, Bianco AJ (1973) Abduction contracture of the shoulders and hips secondary to fibrous bands. J Bone Joint Surg Am 55:844–846

    CAS  Google Scholar 

  36. Ogata K (1983) Clinical and experimental studies on muscle contracture. Nippon Seikeigeka Gakkai Zasshi 57(2):137–150 Article in Japanese

    CAS  Google Scholar 

  37. Levin BE, Engel WK (1975) Iatrogenic muscle fibrosis. Arm levitation as an initial sign. J Am Med Assn 234(6):621–624. doi:10.1001/jama.234.6.621

    Article  CAS  Google Scholar 

  38. Eiserloh H, Drez D Jr, Guanche CA (2000) The long head of the triceps: a detailed analysis if its capsular origin. J Shoulder Elbow Surg 9(4):332–335. doi:10.1067/mse.2000.106466

    Article  CAS  Google Scholar 

  39. Sugalski MT, Wiater JM, Levine WN, Bigliani LU (2005) An anatomic study of the humeral insertion of the inferior glenohumeral capsule. J Shoulder Elbow Surg 14(1):91–95. doi:10.1016/j.jse.2004.04.014

    Article  Google Scholar 

  40. Roberson JR, Dimon JH (1983) Myofibrosis and joint contractures caused by injections of pentazocine. A case report. J Bone Joint Surg Am 65:1007–1009

    CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. National Hospital for Pediatrics, 18/879 La Thanh road, Dong Da district, Hanoi, Vietnam

    Nguyen Ngoc Hung

Authors
  1. Nguyen Ngoc Hung
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Nguyen Ngoc Hung.

About this article

Cite this article

Hung, N.N. Adduction contracture of the shoulder due to fibrous long head of the triceps in children. J Child Orthop 3, 243–249 (2009). https://doi.org/10.1007/s11832-009-0176-7

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11832-009-0176-7

Keywords

Search

Navigation