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Reoperation for failed shoulder reconstruction following brachial plexus birth injury.

Price AE, Fajardo M, Grossman JA - J Brachial Plex Peripher Nerve Inj (2013)

Bottom Line: Various approaches have been developed to treat the progressive shoulder deformity in patients with brachial plexus birth palsy.In each case, we describe the initial attempt(s) at surgical correction, the underlying causes of failure, and the procedures performed to rectify the problem.This case review identifies several aspects of reconstructive shoulder surgery for brachial plexus birth injury that may cause failure of the index procedure(s) and outlines critical steps in the evaluation and execution of shoulder reconstruction.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Orthopaedic Surgery, NYU Hospital for Joint Diseases, New York, USA. aprice@pedsorthoservices.com.

ABSTRACT

Background: Various approaches have been developed to treat the progressive shoulder deformity in patients with brachial plexus birth palsy. Reconstructive surgery for this condition consists of complex procedures with a risk for failure.

Case presentations: This is a retrospective case review of the outcome in eight cases referred to us for reoperation for failed shoulder reconstructions. In each case, we describe the initial attempt(s) at surgical correction, the underlying causes of failure, and the procedures performed to rectify the problem. Results were assessed using pre- and post-operative Mallet shoulder scores. All eight patients realized improvement in shoulder function from reoperation.

Conclusions: This case review identifies several aspects of reconstructive shoulder surgery for brachial plexus birth injury that may cause failure of the index procedure(s) and outlines critical steps in the evaluation and execution of shoulder reconstruction.

No MeSH data available.


Related in: MedlinePlus

Mallet classification of shoulder following obstetrical brachial plexus injury. Total score from all columns: 0–4 indicates minimal function (grade 0); 5–9, poor (grade 1); 10–13, fair (grade 2); 14–17, satisfactory (grade 3); 18–22, good (grade 4); and 22–25, excellent (grade 5). (Adapted from Grossman JAI, Ramos LE, Sumway S, Alfonso I. Management strategies for children with obstetrical brachial plexus injuries. Int Pediatr 1997;12:82–86.)
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Figure 1: Mallet classification of shoulder following obstetrical brachial plexus injury. Total score from all columns: 0–4 indicates minimal function (grade 0); 5–9, poor (grade 1); 10–13, fair (grade 2); 14–17, satisfactory (grade 3); 18–22, good (grade 4); and 22–25, excellent (grade 5). (Adapted from Grossman JAI, Ramos LE, Sumway S, Alfonso I. Management strategies for children with obstetrical brachial plexus injuries. Int Pediatr 1997;12:82–86.)

Mentions: Physical examination of the right upper extremity demonstrated transverse scars overlying the acromion and the axilla, a longitudinal scar over the anteromedial arm, and a visual deformity of the upper arm. She had active shoulder elevation to 80 degrees with a positive clarion or trumpet sign. With the arm adducted, she had no active lateral rotation power; her passive shoulder motion in adduction was from 60 degrees of lateral rotation to 90 degrees of medial rotation. Her Mallet score was 11 (Figure 1)[14,15].


Reoperation for failed shoulder reconstruction following brachial plexus birth injury.

Price AE, Fajardo M, Grossman JA - J Brachial Plex Peripher Nerve Inj (2013)

Mallet classification of shoulder following obstetrical brachial plexus injury. Total score from all columns: 0–4 indicates minimal function (grade 0); 5–9, poor (grade 1); 10–13, fair (grade 2); 14–17, satisfactory (grade 3); 18–22, good (grade 4); and 22–25, excellent (grade 5). (Adapted from Grossman JAI, Ramos LE, Sumway S, Alfonso I. Management strategies for children with obstetrical brachial plexus injuries. Int Pediatr 1997;12:82–86.)
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3750868&req=5

Figure 1: Mallet classification of shoulder following obstetrical brachial plexus injury. Total score from all columns: 0–4 indicates minimal function (grade 0); 5–9, poor (grade 1); 10–13, fair (grade 2); 14–17, satisfactory (grade 3); 18–22, good (grade 4); and 22–25, excellent (grade 5). (Adapted from Grossman JAI, Ramos LE, Sumway S, Alfonso I. Management strategies for children with obstetrical brachial plexus injuries. Int Pediatr 1997;12:82–86.)
Mentions: Physical examination of the right upper extremity demonstrated transverse scars overlying the acromion and the axilla, a longitudinal scar over the anteromedial arm, and a visual deformity of the upper arm. She had active shoulder elevation to 80 degrees with a positive clarion or trumpet sign. With the arm adducted, she had no active lateral rotation power; her passive shoulder motion in adduction was from 60 degrees of lateral rotation to 90 degrees of medial rotation. Her Mallet score was 11 (Figure 1)[14,15].

Bottom Line: Various approaches have been developed to treat the progressive shoulder deformity in patients with brachial plexus birth palsy.In each case, we describe the initial attempt(s) at surgical correction, the underlying causes of failure, and the procedures performed to rectify the problem.This case review identifies several aspects of reconstructive shoulder surgery for brachial plexus birth injury that may cause failure of the index procedure(s) and outlines critical steps in the evaluation and execution of shoulder reconstruction.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Orthopaedic Surgery, NYU Hospital for Joint Diseases, New York, USA. aprice@pedsorthoservices.com.

ABSTRACT

Background: Various approaches have been developed to treat the progressive shoulder deformity in patients with brachial plexus birth palsy. Reconstructive surgery for this condition consists of complex procedures with a risk for failure.

Case presentations: This is a retrospective case review of the outcome in eight cases referred to us for reoperation for failed shoulder reconstructions. In each case, we describe the initial attempt(s) at surgical correction, the underlying causes of failure, and the procedures performed to rectify the problem. Results were assessed using pre- and post-operative Mallet shoulder scores. All eight patients realized improvement in shoulder function from reoperation.

Conclusions: This case review identifies several aspects of reconstructive shoulder surgery for brachial plexus birth injury that may cause failure of the index procedure(s) and outlines critical steps in the evaluation and execution of shoulder reconstruction.

No MeSH data available.


Related in: MedlinePlus