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Anterior Shoulder Release and Tendon Transfer as 1-Stage Procedure for Treatment of Internal Rotation Contracture Deformity in Obstetric Brachial Plexus Injuries

Noaman, Hassan Hamdy MD

doi: 10.1097/SAP.0b013e3182a1b02d
Hand Surgery
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Purpose Children who had internal rotation contracture deformities of the shoulder secondary to obstetric brachial plexus palsy were studied. The outcomes of anterior shoulder release and tendon transfer in 1-stage procedure were analyzed.

Methods Anterior shoulder release and tendon transfer in 2 separate incisions as 1 procedure were performed in 76 patients for improvement of shoulder function. Anterior shoulder release was performed through the deltopectoral incision, starting with the coracoid process that extended 5 cm caudally. Osteotomy of the coracoid process was osteotomized subperiosteally and the pectoralis minor tendon was remained attached to the periosteum. Z-plasty of the subscapularis and resuturing of the pectoralis minor short head of biceps and coracobrachialis to their original position were performed in all cases. A separate second incision in the posterior axillary fold was carried out to perform rerouting of the latissimus dorsi and teres major tendons with a mean follow-up of 5.6 years (range, 1–7 years).

Results The average active external rotation with the arm at the side increased from −26 + 15 degrees preoperatively to 67 + 17 degrees postoperatively (average gain, 85 degrees). The average shoulder abduction increased from 46 + 22 degrees preoperatively to 130 + 32 degrees postoperatively (average gain, 75 degrees). Mallet score improved from 12.3 to 22.6.

Conclusions Anterior shoulder release combined with latissimus dorsi and teres major rerouting significantly improved global shoulder function.

From the Hand and Reconstructive Microsurgical Unit, Orthopaedic Department, Sohag Faculty of Medicine, Sohag University, Sohag, Egypt.

Received April 13, 2013, and accepted for publication, after revision, June 21, 2013.

Conflicts of interest and sources of funding: none declared.

Reprints: Hassan Hamdy Noaman, MD, Hand and Reconstructive Microsurgical Unit, Orthopaedic Department, Sohag Faculty of Medicine, Sohag University, Sohag, Egypt. E-mail: hassan_h@mailcity.com.

© 2013 by Lippincott Williams & Wilkins