Arthroscopic treatment of internal rotation contracture and glenohumeral dysplasia in children with brachial plexus birth palsy
Background The purpose of the study was to assess the ability of arthroscopic anterior release, +/- tendon transfers to maintain shoulder joint alignment in children with brachial plexus palsy, and to assess their outcome after arthroscopic reduction. Methods Forty-four patients underwent arthroscop...
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| Veröffentlicht in: | Journal of shoulder and elbow surgery 2010, Vol.19 (1), p.102-110 |
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| creator | Kozin, Scott H., MD Boardman, Matthew J., DO Chafetz, Ross S., PT, DPT, MPH Williams, Gerald R., MD Hanlon, Alexandra, PhD |
| description | Background The purpose of the study was to assess the ability of arthroscopic anterior release, +/- tendon transfers to maintain shoulder joint alignment in children with brachial plexus palsy, and to assess their outcome after arthroscopic reduction. Methods Forty-four patients underwent arthroscopic release, +/- tendon transfers to realign a dysplastic glenohumeral joint in children with brachial plexus palsy. Twenty-eight children underwent isolated release and 16 children underwent concomitant tendon transfers. MRI and clinical measurements were used to assess outcome at 1-year follow-up. Results There was a significant improvement ( P < .001) in both retroversion from −34 (±15) to -19 (±13), and percentage of the humeral head anterior to the middle of the glenoid fossa (PHHA) from 19% (±12%) to 33% (±12%), at 1 year. Passive external rotation increased from −26 (±20) degrees to 47 (±17) degrees ( P < .001). Active elevation increased from 112 (±28) degrees to 130 (±38) ( P = .008) degrees. Patients that underwent tendon transfers obtained greater active elevation, 147 (±9) degrees compared to 119 (±6) degrees. Mallet aggregate and domain scores also demonstrated statistically significant improvements. Conclusions Our results after arthroscopic release +/- tendon transfers are encouraging with improvements in joint alignment and clinical evaluations following surgery. The clinical improvements paralleled the MRI corrections. Importantly, superior outcomes were associated with better preoperative clinical and MRI status. This indicates that early recognition of glenohumeral dysplasia and timely intervention results in better shoulder motion and improved joint alignment. Level of Evidence 4. |
| doi_str_mv | 10.1016/j.jse.2009.05.011 |
| format | Article |
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Methods Forty-four patients underwent arthroscopic release, +/- tendon transfers to realign a dysplastic glenohumeral joint in children with brachial plexus palsy. Twenty-eight children underwent isolated release and 16 children underwent concomitant tendon transfers. MRI and clinical measurements were used to assess outcome at 1-year follow-up. Results There was a significant improvement ( P < .001) in both retroversion from −34 (±15) to -19 (±13), and percentage of the humeral head anterior to the middle of the glenoid fossa (PHHA) from 19% (±12%) to 33% (±12%), at 1 year. Passive external rotation increased from −26 (±20) degrees to 47 (±17) degrees ( P < .001). Active elevation increased from 112 (±28) degrees to 130 (±38) ( P = .008) degrees. Patients that underwent tendon transfers obtained greater active elevation, 147 (±9) degrees compared to 119 (±6) degrees. Mallet aggregate and domain scores also demonstrated statistically significant improvements. Conclusions Our results after arthroscopic release +/- tendon transfers are encouraging with improvements in joint alignment and clinical evaluations following surgery. The clinical improvements paralleled the MRI corrections. Importantly, superior outcomes were associated with better preoperative clinical and MRI status. This indicates that early recognition of glenohumeral dysplasia and timely intervention results in better shoulder motion and improved joint alignment. Level of Evidence 4.</description><identifier>ISSN: 1058-2746</identifier><identifier>EISSN: 1532-6500</identifier><identifier>DOI: 10.1016/j.jse.2009.05.011</identifier><identifier>PMID: 19664938</identifier><language>eng</language><publisher>New York, NY: Mosby, Inc</publisher><subject>Analysis of Variance ; Arthroscopy ; Arthroscopy - methods ; Biological and medical sciences ; Birth Injuries - complications ; Birth Injuries - diagnosis ; Brachial Plexus Neuropathies - complications ; Brachial Plexus Neuropathies - diagnosis ; Child ; Child, Preschool ; Cohort Studies ; Contracture - etiology ; Contracture - surgery ; Diseases of the osteoarticular system ; Endoscopy ; Female ; Follow-Up Studies ; Humans ; Infant ; Investigative techniques, diagnostic techniques (general aspects) ; Joint Deformities, Acquired - etiology ; Joint Deformities, Acquired - surgery ; Magnetic Resonance Imaging ; Male ; Medical sciences ; Minimally Invasive Surgical Procedures - methods ; Nervous system (semeiology, syndromes) ; Nervous system as a whole ; Neurology ; Orthopedics ; Probability ; Range of Motion, Articular - physiology ; Recovery of Function ; Retrospective Studies ; Shoulder Joint - physiopathology ; Shoulder Joint - surgery ; Tendon Transfer - methods ; Treatment Outcome</subject><ispartof>Journal of shoulder and elbow surgery, 2010, Vol.19 (1), p.102-110</ispartof><rights>Journal of Shoulder and Elbow Surgery Board of Trustees</rights><rights>2010 Journal of Shoulder and Elbow Surgery Board of Trustees</rights><rights>2015 INIST-CNRS</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c437t-85bca90c119d027b18847d713096038d183a02d20e85a0220f26d43603ce7c6a3</citedby><cites>FETCH-LOGICAL-c437t-85bca90c119d027b18847d713096038d183a02d20e85a0220f26d43603ce7c6a3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://dx.doi.org/10.1016/j.jse.2009.05.011$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,780,784,3548,4022,27921,27922,27923,45993</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=22288376$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/19664938$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Kozin, Scott H., MD</creatorcontrib><creatorcontrib>Boardman, Matthew J., DO</creatorcontrib><creatorcontrib>Chafetz, Ross S., PT, DPT, MPH</creatorcontrib><creatorcontrib>Williams, Gerald R., MD</creatorcontrib><creatorcontrib>Hanlon, Alexandra, PhD</creatorcontrib><title>Arthroscopic treatment of internal rotation contracture and glenohumeral dysplasia in children with brachial plexus birth palsy</title><title>Journal of shoulder and elbow surgery</title><addtitle>J Shoulder Elbow Surg</addtitle><description>Background The purpose of the study was to assess the ability of arthroscopic anterior release, +/- tendon transfers to maintain shoulder joint alignment in children with brachial plexus palsy, and to assess their outcome after arthroscopic reduction. Methods Forty-four patients underwent arthroscopic release, +/- tendon transfers to realign a dysplastic glenohumeral joint in children with brachial plexus palsy. Twenty-eight children underwent isolated release and 16 children underwent concomitant tendon transfers. MRI and clinical measurements were used to assess outcome at 1-year follow-up. Results There was a significant improvement ( P < .001) in both retroversion from −34 (±15) to -19 (±13), and percentage of the humeral head anterior to the middle of the glenoid fossa (PHHA) from 19% (±12%) to 33% (±12%), at 1 year. Passive external rotation increased from −26 (±20) degrees to 47 (±17) degrees ( P < .001). Active elevation increased from 112 (±28) degrees to 130 (±38) ( P = .008) degrees. Patients that underwent tendon transfers obtained greater active elevation, 147 (±9) degrees compared to 119 (±6) degrees. Mallet aggregate and domain scores also demonstrated statistically significant improvements. Conclusions Our results after arthroscopic release +/- tendon transfers are encouraging with improvements in joint alignment and clinical evaluations following surgery. The clinical improvements paralleled the MRI corrections. Importantly, superior outcomes were associated with better preoperative clinical and MRI status. This indicates that early recognition of glenohumeral dysplasia and timely intervention results in better shoulder motion and improved joint alignment. Level of Evidence 4.</description><subject>Analysis of Variance</subject><subject>Arthroscopy</subject><subject>Arthroscopy - methods</subject><subject>Biological and medical sciences</subject><subject>Birth Injuries - complications</subject><subject>Birth Injuries - diagnosis</subject><subject>Brachial Plexus Neuropathies - complications</subject><subject>Brachial Plexus Neuropathies - diagnosis</subject><subject>Child</subject><subject>Child, Preschool</subject><subject>Cohort Studies</subject><subject>Contracture - etiology</subject><subject>Contracture - surgery</subject><subject>Diseases of the osteoarticular system</subject><subject>Endoscopy</subject><subject>Female</subject><subject>Follow-Up Studies</subject><subject>Humans</subject><subject>Infant</subject><subject>Investigative techniques, diagnostic techniques (general aspects)</subject><subject>Joint Deformities, Acquired - etiology</subject><subject>Joint Deformities, Acquired - surgery</subject><subject>Magnetic Resonance Imaging</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Minimally Invasive Surgical Procedures - methods</subject><subject>Nervous system (semeiology, syndromes)</subject><subject>Nervous system as a whole</subject><subject>Neurology</subject><subject>Orthopedics</subject><subject>Probability</subject><subject>Range of Motion, Articular - physiology</subject><subject>Recovery of Function</subject><subject>Retrospective Studies</subject><subject>Shoulder Joint - physiopathology</subject><subject>Shoulder Joint - surgery</subject><subject>Tendon Transfer - methods</subject><subject>Treatment Outcome</subject><issn>1058-2746</issn><issn>1532-6500</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2010</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kk2LFDEQhhtR3N3RH-BFchFP01aS_kgjCMuiq7DgQT2HdFJtp-1O2iTtOif_uhlmUPDgKQV53qrwpIriGYWSAm1eTeUUsWQAXQl1CZQ-KC5pzdm-qQEe5hpqsWdt1VwUVzFOkMEK2OPignZNU3VcXBa_rkMag4_ar1aTFFClBV0ifiDWJQxOzST4pJL1jmjvUlA6bQGJcoZ8ndH5cVswZMoc4jqraFUOEj3a2QR05N6mkfQ5NNrMrDP-3CLpbR5KVjXHw5Pi0ZBPfHo-d8WXd28_37zf3328_XBzfbfXFW_TXtS9Vh1oSjsDrO2pEFVrWsqha4ALQwVXwAwDFHUuGAysMRXPdxpb3Si-K16e-q7Bf98wJrnYqHGelUO_RdlyzkVb5T67gp5InbXEgINcg11UOEgK8qhdTjJrl0ftEmqZtefM83P3rV_Q_E2cPWfgxRlQUat5CMppG_9wjDEheNtk7vWJw-zih8Ugo7boNBobUCdpvP3vM978k9azdTYP_IYHjJPfjv8ZJZWRSZCfjvtxXA_oABhvav4blnW2lg</recordid><startdate>2010</startdate><enddate>2010</enddate><creator>Kozin, Scott H., MD</creator><creator>Boardman, Matthew J., DO</creator><creator>Chafetz, Ross S., PT, DPT, MPH</creator><creator>Williams, Gerald R., MD</creator><creator>Hanlon, Alexandra, PhD</creator><general>Mosby, Inc</general><general>Elsevier</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>2010</creationdate><title>Arthroscopic treatment of internal rotation contracture and glenohumeral dysplasia in children with brachial plexus birth palsy</title><author>Kozin, Scott H., MD ; Boardman, Matthew J., DO ; Chafetz, Ross S., PT, DPT, MPH ; Williams, Gerald R., MD ; Hanlon, Alexandra, PhD</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c437t-85bca90c119d027b18847d713096038d183a02d20e85a0220f26d43603ce7c6a3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2010</creationdate><topic>Analysis of Variance</topic><topic>Arthroscopy</topic><topic>Arthroscopy - methods</topic><topic>Biological and medical sciences</topic><topic>Birth Injuries - complications</topic><topic>Birth Injuries - diagnosis</topic><topic>Brachial Plexus Neuropathies - complications</topic><topic>Brachial Plexus Neuropathies - diagnosis</topic><topic>Child</topic><topic>Child, Preschool</topic><topic>Cohort Studies</topic><topic>Contracture - etiology</topic><topic>Contracture - surgery</topic><topic>Diseases of the osteoarticular system</topic><topic>Endoscopy</topic><topic>Female</topic><topic>Follow-Up Studies</topic><topic>Humans</topic><topic>Infant</topic><topic>Investigative techniques, diagnostic techniques (general aspects)</topic><topic>Joint Deformities, Acquired - etiology</topic><topic>Joint Deformities, Acquired - surgery</topic><topic>Magnetic Resonance Imaging</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Minimally Invasive Surgical Procedures - methods</topic><topic>Nervous system (semeiology, syndromes)</topic><topic>Nervous system as a whole</topic><topic>Neurology</topic><topic>Orthopedics</topic><topic>Probability</topic><topic>Range of Motion, Articular - physiology</topic><topic>Recovery of Function</topic><topic>Retrospective Studies</topic><topic>Shoulder Joint - physiopathology</topic><topic>Shoulder Joint - surgery</topic><topic>Tendon Transfer - methods</topic><topic>Treatment Outcome</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Kozin, Scott H., MD</creatorcontrib><creatorcontrib>Boardman, Matthew J., DO</creatorcontrib><creatorcontrib>Chafetz, Ross S., PT, DPT, MPH</creatorcontrib><creatorcontrib>Williams, Gerald R., MD</creatorcontrib><creatorcontrib>Hanlon, Alexandra, PhD</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Journal of shoulder and elbow surgery</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Kozin, Scott H., MD</au><au>Boardman, Matthew J., DO</au><au>Chafetz, Ross S., PT, DPT, MPH</au><au>Williams, Gerald R., MD</au><au>Hanlon, Alexandra, PhD</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Arthroscopic treatment of internal rotation contracture and glenohumeral dysplasia in children with brachial plexus birth palsy</atitle><jtitle>Journal of shoulder and elbow surgery</jtitle><addtitle>J Shoulder Elbow Surg</addtitle><date>2010</date><risdate>2010</risdate><volume>19</volume><issue>1</issue><spage>102</spage><epage>110</epage><pages>102-110</pages><issn>1058-2746</issn><eissn>1532-6500</eissn><abstract>Background The purpose of the study was to assess the ability of arthroscopic anterior release, +/- tendon transfers to maintain shoulder joint alignment in children with brachial plexus palsy, and to assess their outcome after arthroscopic reduction. Methods Forty-four patients underwent arthroscopic release, +/- tendon transfers to realign a dysplastic glenohumeral joint in children with brachial plexus palsy. Twenty-eight children underwent isolated release and 16 children underwent concomitant tendon transfers. MRI and clinical measurements were used to assess outcome at 1-year follow-up. Results There was a significant improvement ( P < .001) in both retroversion from −34 (±15) to -19 (±13), and percentage of the humeral head anterior to the middle of the glenoid fossa (PHHA) from 19% (±12%) to 33% (±12%), at 1 year. Passive external rotation increased from −26 (±20) degrees to 47 (±17) degrees ( P < .001). Active elevation increased from 112 (±28) degrees to 130 (±38) ( P = .008) degrees. Patients that underwent tendon transfers obtained greater active elevation, 147 (±9) degrees compared to 119 (±6) degrees. Mallet aggregate and domain scores also demonstrated statistically significant improvements. Conclusions Our results after arthroscopic release +/- tendon transfers are encouraging with improvements in joint alignment and clinical evaluations following surgery. The clinical improvements paralleled the MRI corrections. Importantly, superior outcomes were associated with better preoperative clinical and MRI status. This indicates that early recognition of glenohumeral dysplasia and timely intervention results in better shoulder motion and improved joint alignment. Level of Evidence 4.</abstract><cop>New York, NY</cop><pub>Mosby, Inc</pub><pmid>19664938</pmid><doi>10.1016/j.jse.2009.05.011</doi><tpages>9</tpages></addata></record> |
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| subjects | Analysis of Variance Arthroscopy Arthroscopy - methods Biological and medical sciences Birth Injuries - complications Birth Injuries - diagnosis Brachial Plexus Neuropathies - complications Brachial Plexus Neuropathies - diagnosis Child Child, Preschool Cohort Studies Contracture - etiology Contracture - surgery Diseases of the osteoarticular system Endoscopy Female Follow-Up Studies Humans Infant Investigative techniques, diagnostic techniques (general aspects) Joint Deformities, Acquired - etiology Joint Deformities, Acquired - surgery Magnetic Resonance Imaging Male Medical sciences Minimally Invasive Surgical Procedures - methods Nervous system (semeiology, syndromes) Nervous system as a whole Neurology Orthopedics Probability Range of Motion, Articular - physiology Recovery of Function Retrospective Studies Shoulder Joint - physiopathology Shoulder Joint - surgery Tendon Transfer - methods Treatment Outcome |
| title | Arthroscopic treatment of internal rotation contracture and glenohumeral dysplasia in children with brachial plexus birth palsy |
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