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Isolated open anterior shoulder release improved brachial plexus birth palsy outcomes
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Published results showed isolated open anterior release of the shoulder reduced posterior joint subluxation and improved passive and active shoulder ranges of motion in patients with brachial plexus birth palsy.
Among 40 patients with brachial plexus birth palsy and glenohumeral dysplasia who underwent open anterior shoulder release, researchers conducted MRI preoperatively and CT postoperatively to assess glenoid version and the percentage of the humeral head anterior to the middle of the glenoid fossa. Researchers collected clinical data, including analytical shoulder range of motion and modified Mallet scores.
Results showed a significant improvement in glenoid version from –32° preoperatively to a mean postoperative value of –12° after a mean follow-up period of 23 months. Similarly, the percentage of the humeral head anterior to the middle of the glenoid fossa showed significant improvement from 18% preoperatively to a mean postoperative value of 45%. Researchers found an increase in passive external rotation from –2° to 76°, as well as an increase in active external rotation from –43° to 54°. Results showed significant improvements in the mean modified Mallet score from 14.2 points to 21.4 points. Researchers performed a latissimus dorsi transfer secondarily to obtain satisfactory active motion in eight children with satisfactory passive motion. – by Casey Tingle
Disclosures: The authors report no relevant financial disclosures.
Perspective
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Andrea S. Bauer, MD
In their paper “Isolated open anterior shoulder release in brachial plexus birth palsy,” Marion Burnier, MD, and colleagues present a single-surgeon series of 40 patients between the ages of 1 year to 12 years with glenohumeral dysplasia related to brachial plexus birth injury (BPBI) who underwent an open anterior shoulder release. The authors demonstrate improvement in external rotation, abduction, modified Mallet scores and radiographic parameters. Loss of internal rotation, a known risk of anterior release, was not formally evaluated, however.
This paper builds on a broad base of research in this area. It is well-known that both open and arthroscopic releases of the shoulder can lead to glenohumeral joint remodeling and improved motion in patients with BPBI. There is wide variation in how these shoulder releases are performed, however. While Burnier and colleagues describe excellent results, these results are similar to those reported in many other series of shoulder releases with and without tendon transfers.
The BPBI research community is making strides in standardizing data collection to better compare these various procedures. Willem Pondaag, MD, PhD, and Martijn J.A. Malessy, MD, PhD, recently led an international Delphi process to establish a standardized set of clinical measures to be used in BPBI research. Utilizing these standardized measures is a great first step toward understanding which shoulder procedures are truly best for our patients with BPBI.
References:
Pearl ML. Arthroscopy. 2003;doi:10.1016/S0749-8063(03)00390-6.
Pondaag W, et al. J Orthop Res. 2018;doi:10.1002/jor.23901.
Waters PM, et al. J Bone Joint Surg Am. 2008;doi:10.2106/JBJS.G.01517.
Boston Children’s Hospital
Boston
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