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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

Example of faulty harvest and insertion of transferred tendon.
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Figure 2: Example of faulty harvest and insertion of transferred tendon.

Mentions: RS was a 4-year-old boy who presented with right Erb’s palsy. At age 6 months he had undergone brachial plexus exploration with nerve grafting. The details of the operation were not available for review. At 18 months of age, he underwent open anterior subscapularis release, transfer of the teres major, axillary nerve neurolysis, and pectoralis major release. At age 6, he had shoulder elevation to 120 degrees with a severe clarion sign. His passive lateral rotation of the shoulder in adduction was to 0 degrees; his Mallet score was 13. At exploration, the teres major was split in half and attached to the posterior edge of the deltoid (Figure 2). We performed a subscapularis slide and repaired the teres major to the rest of the muscle which had remained in its anatomic site. The latissimus dorsi was detached from the humerus and transferred into the infraspinatus tendon. At 18 months postsurgery, he had 170 degrees of active shoulder elevation and a negative clarion sign. His postoperative Mallet score was 18.


Reoperation for failed shoulder reconstruction following brachial plexus birth injury.

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

Example of faulty harvest and insertion of transferred tendon.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 2: Example of faulty harvest and insertion of transferred tendon.
Mentions: RS was a 4-year-old boy who presented with right Erb’s palsy. At age 6 months he had undergone brachial plexus exploration with nerve grafting. The details of the operation were not available for review. At 18 months of age, he underwent open anterior subscapularis release, transfer of the teres major, axillary nerve neurolysis, and pectoralis major release. At age 6, he had shoulder elevation to 120 degrees with a severe clarion sign. His passive lateral rotation of the shoulder in adduction was to 0 degrees; his Mallet score was 13. At exploration, the teres major was split in half and attached to the posterior edge of the deltoid (Figure 2). We performed a subscapularis slide and repaired the teres major to the rest of the muscle which had remained in its anatomic site. The latissimus dorsi was detached from the humerus and transferred into the infraspinatus tendon. At 18 months postsurgery, he had 170 degrees of active shoulder elevation and a negative clarion sign. His postoperative Mallet score was 18.

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