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Journal of Bone and Joint Surgery - British Volume, Vol 89-B, Issue 5,
620-626.
doi: 10.1302/0301-620X.89B5.18403 Copyright © 2007 by British Editorial Society of Bone and Joint Surgery Improvement in abduction of the shoulder after reconstructive soft-tissue procedures in obstetric brachial plexus palsyR. K. Nath, MD, Plastic and Reconstructive Surgeon1; and M. Paizi, DSc, Research Scientist11 Texas Nerve and Paralysis Institute, 2201 West Holcombe, Boulevard, Houston, Texas, 77030, USA. Correspondence should be sent to Mr R. K. Nath; e-mail: nath{at}drnathmedical.com
Residual muscle weakness in obstetric brachial plexus palsy results in soft-tissue contractures which limit the functional range of movement and lead to progressive glenoid dysplasia and joint instability. We describe the results of surgical treatment in 98 patients (mean age 2.5 years, 0.5 to 9.0) for the correction of active abduction of the shoulder. The patients underwent transfer of the latissimus dorsi and teres major muscles, release of contractures of subscapularis pectoralis major and minor, and axillary nerve decompression and neurolysis (the modified Quad procedure). The transferred muscles were sutured to the teres minor muscle, not to a point of bony insertion. The mean pre-operative active abduction was 45° (20° to 90°). At a mean follow-up of 4.8 years (2.0 to 8.7), the mean active abduction was 162° (100° to 180°) while 77 (78.6%) of the patients had active abduction of 160° or more. No decline in abduction was noted among the 29 patients (29.6%) followed up for six years or more. This procedure involving release of the contracted internal rotators of the shoulder combined with decompression and neurolysis of the axillary nerve greatly improves active abduction in young patients with muscle imbalance secondary to obstetric brachial plexus palsy. This article has been cited by other articles:
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