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Triangle tilt surgery: effect on coracohumeral distance and external rotation of the glenohumeral joint.

Nath RK, Mahmooduddin F - Eplasty (2010)

Bottom Line: Coracohumeral distance (P < .0006), total Mallet score (P < .0001), supination angle (P < .0001), and individual Mallet scores for all external rotation parameters including hand-to-mouth (P < .0001), supination (P = .0010), external rotation (P < .0001), hand-to-neck (P < .0001), and hand-to-spine (P = .0064) were significantly higher postoperatively than preoperatively for affected shoulders.Hand-to-mouth angles were significantly lower postoperatively than preoperatively (P < .0001).Increasing coracohumeral distance significantly improves all external rotation parameters and total Mallet scores.

View Article: PubMed Central - PubMed

Affiliation: Texas Nerve and Paralysis Institute, 6400 Fannin St, Ste 2420, Houston, TX.

ABSTRACT

Objective: Shoulder muscle imbalances and bone deformities that develop secondary to obstetric brachial plexus injury have been extensively studied. Less emphasis has focused on coracohumeral distance, a small value potentially being linked to impaired shoulder external rotation. The purpose of this study is to analyze coracohumeral distances and shoulder external rotation in obstetric brachial plexus injury patients before and after triangle tilt surgery.

Methods: Twenty patients with deformities secondary to obstetric brachial plexus injury were included. Coracohumeral distances were measured on computed tomographic images. Clinical functioning was evaluated through video recordings by using a modified Mallet scale. Paired Student t tests were used to determine statistical significance of anatomic and functional parameters, pre- and postoperatively.

Results: Coracohumeral distance (P < .0006), total Mallet score (P < .0001), supination angle (P < .0001), and individual Mallet scores for all external rotation parameters including hand-to-mouth (P < .0001), supination (P = .0010), external rotation (P < .0001), hand-to-neck (P < .0001), and hand-to-spine (P = .0064) were significantly higher postoperatively than preoperatively for affected shoulders. Hand-to-mouth angles were significantly lower postoperatively than preoperatively (P < .0001). Coracohumeral distance in unaffected shoulders remained unchanged.

Conclusions: Triangle tilt surgery significantly improves coracohumeral distance and clinical functioning in obstetric brachial plexus injury patients. Coracohumeral distance plays a key role in shoulder external rotation. Increasing coracohumeral distance significantly improves all external rotation parameters and total Mallet scores. The triangle tilt surgery relieves excessive tightness of the anterior stabilizing complex, widens coracohumeral distance, and improves external rotation of shoulder.

No MeSH data available.


Related in: MedlinePlus

The Nath Modification of Mallet's System: clinical scoring of function. In addition to assessing the classical functions of the Modified Mallet system, supination and the resting position are evaluated. To further define deformity, fixed forearm supination (positions 2S, 3S, and 4S) as well as external rotation position (5E) are scored.
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Figure 2: The Nath Modification of Mallet's System: clinical scoring of function. In addition to assessing the classical functions of the Modified Mallet system, supination and the resting position are evaluated. To further define deformity, fixed forearm supination (positions 2S, 3S, and 4S) as well as external rotation position (5E) are scored.

Mentions: All the measurements were performed by a trained scientist (F.M.) independent of the surgeon and senior author. Graphic software (Universal Desktop Ruler, AVP-Soft.com, Voronezh, Russia) was used for all measurements made on axial CT images. Distance was measured in pixels and converted into standard length units as millimeters. Clinical functioning of patients was evaluated preoperatively and postoperatively through video recordings using a modified Mallet scale (Fig 2). Global abduction was not measured, as it is addressed with the modified quad surgery. The TT surgery is designed to address only external rotation deficiencies of shoulder.


Triangle tilt surgery: effect on coracohumeral distance and external rotation of the glenohumeral joint.

Nath RK, Mahmooduddin F - Eplasty (2010)

The Nath Modification of Mallet's System: clinical scoring of function. In addition to assessing the classical functions of the Modified Mallet system, supination and the resting position are evaluated. To further define deformity, fixed forearm supination (positions 2S, 3S, and 4S) as well as external rotation position (5E) are scored.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2990465&req=5

Figure 2: The Nath Modification of Mallet's System: clinical scoring of function. In addition to assessing the classical functions of the Modified Mallet system, supination and the resting position are evaluated. To further define deformity, fixed forearm supination (positions 2S, 3S, and 4S) as well as external rotation position (5E) are scored.
Mentions: All the measurements were performed by a trained scientist (F.M.) independent of the surgeon and senior author. Graphic software (Universal Desktop Ruler, AVP-Soft.com, Voronezh, Russia) was used for all measurements made on axial CT images. Distance was measured in pixels and converted into standard length units as millimeters. Clinical functioning of patients was evaluated preoperatively and postoperatively through video recordings using a modified Mallet scale (Fig 2). Global abduction was not measured, as it is addressed with the modified quad surgery. The TT surgery is designed to address only external rotation deficiencies of shoulder.

Bottom Line: Coracohumeral distance (P < .0006), total Mallet score (P < .0001), supination angle (P < .0001), and individual Mallet scores for all external rotation parameters including hand-to-mouth (P < .0001), supination (P = .0010), external rotation (P < .0001), hand-to-neck (P < .0001), and hand-to-spine (P = .0064) were significantly higher postoperatively than preoperatively for affected shoulders.Hand-to-mouth angles were significantly lower postoperatively than preoperatively (P < .0001).Increasing coracohumeral distance significantly improves all external rotation parameters and total Mallet scores.

View Article: PubMed Central - PubMed

Affiliation: Texas Nerve and Paralysis Institute, 6400 Fannin St, Ste 2420, Houston, TX.

ABSTRACT

Objective: Shoulder muscle imbalances and bone deformities that develop secondary to obstetric brachial plexus injury have been extensively studied. Less emphasis has focused on coracohumeral distance, a small value potentially being linked to impaired shoulder external rotation. The purpose of this study is to analyze coracohumeral distances and shoulder external rotation in obstetric brachial plexus injury patients before and after triangle tilt surgery.

Methods: Twenty patients with deformities secondary to obstetric brachial plexus injury were included. Coracohumeral distances were measured on computed tomographic images. Clinical functioning was evaluated through video recordings by using a modified Mallet scale. Paired Student t tests were used to determine statistical significance of anatomic and functional parameters, pre- and postoperatively.

Results: Coracohumeral distance (P < .0006), total Mallet score (P < .0001), supination angle (P < .0001), and individual Mallet scores for all external rotation parameters including hand-to-mouth (P < .0001), supination (P = .0010), external rotation (P < .0001), hand-to-neck (P < .0001), and hand-to-spine (P = .0064) were significantly higher postoperatively than preoperatively for affected shoulders. Hand-to-mouth angles were significantly lower postoperatively than preoperatively (P < .0001). Coracohumeral distance in unaffected shoulders remained unchanged.

Conclusions: Triangle tilt surgery significantly improves coracohumeral distance and clinical functioning in obstetric brachial plexus injury patients. Coracohumeral distance plays a key role in shoulder external rotation. Increasing coracohumeral distance significantly improves all external rotation parameters and total Mallet scores. The triangle tilt surgery relieves excessive tightness of the anterior stabilizing complex, widens coracohumeral distance, and improves external rotation of shoulder.

No MeSH data available.


Related in: MedlinePlus