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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

Preoperative computed tomography of a patient with obstetric brachial plexus injuries included in this study showing coracohumeral distance, labeled “CHD.” Scale is shown at bottom. Space between each hache mark is 10 mm. CHD = 35 mm.
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Figure 3: Preoperative computed tomography of a patient with obstetric brachial plexus injuries included in this study showing coracohumeral distance, labeled “CHD.” Scale is shown at bottom. Space between each hache mark is 10 mm. CHD = 35 mm.

Mentions: Coracohumeral distance, measured from the most proximal aspect of the coracoid tip to the calculated center of the ossified humeral head visible on the axial CT image, was significantly higher postoperatively than preoperative values (mean: 31.1 mm vs 27.6 mm; difference in means: 3.5 mm; P < .0006) for affected shoulders. Figures 3 and 4 show the pre- and postoperative CTs, respectively, with coracohumeral distances on the same OBPI patient. In the unaffected shoulders, coracohumeral distance remained unchanged during the same time frame.


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

Nath RK, Mahmooduddin F - Eplasty (2010)

Preoperative computed tomography of a patient with obstetric brachial plexus injuries included in this study showing coracohumeral distance, labeled “CHD.” Scale is shown at bottom. Space between each hache mark is 10 mm. CHD = 35 mm.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 3: Preoperative computed tomography of a patient with obstetric brachial plexus injuries included in this study showing coracohumeral distance, labeled “CHD.” Scale is shown at bottom. Space between each hache mark is 10 mm. CHD = 35 mm.
Mentions: Coracohumeral distance, measured from the most proximal aspect of the coracoid tip to the calculated center of the ossified humeral head visible on the axial CT image, was significantly higher postoperatively than preoperative values (mean: 31.1 mm vs 27.6 mm; difference in means: 3.5 mm; P < .0006) for affected shoulders. Figures 3 and 4 show the pre- and postoperative CTs, respectively, with coracohumeral distances on the same OBPI patient. In the unaffected shoulders, coracohumeral distance remained unchanged during the same time frame.

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