Comparing the Results of Latissimus Dorsi Versus Teres Major Transfer in Children With Obstetric Brachial Plexus Injury and Residual Shoulder Sequelae.

BACKGROUND: Obstetric brachial plexus injury (OBPI) remains a fairly common problem in newborns despite the improved obstetric care. Children who do not show complete recovery often present with residual shoulder deformity of limited external rotation and abduction. Secondary interventions in the form of tendon transfer and soft tissue release are aimed at correcting the implicated muscular imbalance to restore shoulder function. AIM: The aim of this work was to compare the results of latissimus dorsi versus teres major tendon transfer in patients with OBPI with limited shoulder external rotation. PATIENTS AND METHODS: This study included 40 patients admitted to El Hadara University Hospital with OBPI and limited shoulder abduction and external rotation aged between 1.5 and 4 years. Half of the patients had a latissimus dorsi transfer, and the other half, a teres major one. Children with limited preoperative passive external rotation in both groups required a subscapularis slide. Patients were evaluated preoperatively, at 6 months, and 12 months postoperatively using the Gilbert scale. RESULTS: Teres major tendon transfer showed better results in restoring limited shoulder abduction and external rotation than latissimus dorsi transfer. Limited shoulder internal rotation was the main complication occurring postoperatively. Loss of the last degree of internal rotation occurred in most patients who had subscapularis slide. Most patients regained functional midline abilities with physiotherapy and required no further interventions. CONCLUSIONS: Isolated teres major transfer has shown better results in improving the range of external rotation and abduction compared with isolated latissimus dorsi tendon transfer. Age of the patients did not affect the overall final improvement in shoulder range of motion. Limited internal rotation is the main complication postoperatively, which was prevalent in patients who required a subscapularis slide but was not statistically significant.

The Effect of Distal Transfer of the Spinal Accessory Nerve to the Suprascapular Nerve on the Shoulder Reanimation in Spontaneously Partially Recovered Obstetric Brachial Plexus Lesion.

BACKGROUND: Spontaneous recovery of elbow flexion in obstetric brachial plexus palsy at 4 to 6 months of age is sufficient to exclude the child from the early microsurgical intervention. However, lack of complete active external rotation of shoulder is a common finding in such cases despite ongoing other arm and shoulder functions. Nerve transfer is proposed to manage such cases before the age of 18 months. AIM: The aim of this study was to study the distal transfer of the spinal accessory nerve to the suprascapular nerve through posterior approach and its effect on the shoulder reanimation in patients with obstetric brachial plexus lesion who had spontaneously recovered biceps function but not shoulder function before the age of 18 months. PATIENTS AND METHODS: This prospective study included 20 patients admitted to Elhadra University Hospital with obstetric brachial plexus lesion aged between 10 and 18 months with spontaneous recovery of biceps function, weak active shoulder abduction grade 4 or grade 5 and deficient active shoulder external rotation. All patients were assessed preoperative and postoperative by Active Movement Scale. RESULTS: Active shoulder external rotation improved in all patients at the end of follow-up period, whereas the shoulder abduction improved in 80%. Early surgery in patient younger than 16 months shows better results. CONCLUSIONS: The distal transfer of spinal accessory nerve to suprascapular nerve is an effective method for active shoulder abduction and external rotation recovery in spontaneously recovered elbow flexion in obstetric brachial plexus lesions. Better results are obtained in patients younger than 16 months old. Early transfer balances the forces around the shoulder joint, preventing shoulder internal rotation contracture.