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Humeral Retroversion in Children with Shoulder Internal Rotation Contractures Secondary to Upper-Trunk Neonatal Brachial Plexus Palsy

Pearl, Michael L. MD; Batech, Michael DrPH; van de Bunt, Fabian MD

Journal of Bone & Joint Surgery - American Volume: 7 December 2016 - Volume 98 - Issue 23 - p 1988–1995
doi: 10.2106/JBJS.15.01132
Scientific Articles

Background: The most common sequela of neonatal brachial plexus palsy is an internal rotation contracture of the shoulder that impairs function and leads to skeletal deformation of the glenohumeral joint. Treatment options include release, transfers, and humeral osteotomy, all ultimately striving for better function through increased external rotation. Prior studies have shown that neonatal brachial plexus palsy alters humeral retroversion but with conflicting findings. We studied retroversion in children with internal rotation contractures from neonatal brachial plexus palsy to clarify its effect on version and surgical planning.

Methods: Bilateral shoulder and elbow magnetic resonance imaging scans of 21 children with neonatal brachial plexus palsy were retrospectively analyzed. Retroversion referenced to the transepicondylar line at the elbow was measured with respect to 2 different proximal reference axes, the longest diameter of an axial cut of the proximal part of the humerus (the skew axis) and the line perpendicular to the articular surface (the humeral center line). Glenoid version and glenohumeral morphology type (concentric glenoid, posterior-concentric glenoid, biconcave, or pseudoglenoid) were also determined. All geometric variables were assessed for correlation with patient age and the severity of the internal rotation contracture.

Results: Retroversion on the involved side was decreased at 6° compared with 19° (p = 0.003), as measured between the skew axis and transepicondylar line. Retroversion referenced to the humeral center line was also decreased at −2° (anteversion) compared with 20° (p < 0.001). Patient age was inversely correlated with retroversion, but was only significant for the skew axis (r = −0.497, p = 0.022), decreasing in linear regression by 2.4° per year (p = 0.038). Humeral retroversion did not correlate with the severity of the internal rotation contracture, glenoid version, or glenoid morphology type.

Conclusions: Humeral retroversion is likely to be less on the affected side in children with internal rotation contractures from upper trunk neonatal brachial plexus palsy and merits consideration in surgical planning.

Level of Evidence: Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.

1Department of Orthopaedics, Kaiser Permanente, Los Angeles, California

2Division of Biostatistics, Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, California

3Department of Orthopaedics, Vrije Universiteit, Amsterdam, the Netherlands

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Copyright 2016 by The Journal of Bone and Joint Surgery, Incorporated
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