Tendon transfer around shoulder and rehabilitation in obstetric brachial plexus paralysis: clinical and computed tomographic study

ABSTRACT

109 obstetrical palsy patients with defective shoulder abduction and external rotation had subscapularis release and transfer of teres major to infraspinatus with or without pedicle transfer of the clavicular head of pectoralis major to deltoid The age at surgery averaged 67 [11-1 92] months and Follow-up averaged 36 [12-80] months. 39 cases had follow-up CT scan of both shoulders. Improvement of abduction averaged 64 0 and that of external rotation 50 0, 100% and 290% gain, respectively. Both negatively correlated with the age at surgery [p<0.001], and were significantly higher in patients operated < 4 years old. On CT scans, the degree of glenoid retroversion positively correlated [p<0. 001] with the age at surgery, and was significantly higher in patients operated >4 years old The degree of posterior subluxation showed no significant difference between different ages. There was no significant difference between the operated and normal sides in patients operated < 4 years old as regards glenoid retroversion and in those operated <2 years old as regards posterior subluxation. The operation is useful for correction of defective shoulder abduction and external rotation in obstetric palsy. It is best performed before the age of two to get maximal improvement in motion and prevent secondary bone changes. Between the ages of 2-4, it also resulted in significant improvement in motion and prevented glenoid retroversion, but not posterior subluxation. After the age of 4, the improvement in motion was not significant and secondary bone changes were not prevented