Arthroscopic Treatment of Shoulder Internal Rotation Contracture In Children Secondary To Obstetric Brachial Plexus Birth Palsy

Abstract

Background: Children who had been delivered with brachial plexus injury often presented with ‎debilitating condition when their shoulder becomes stuck in an inwardly rotated position. Instances of ‎inadequate recuperation following physiotherapy necessitate several surgical alternatives, such as soft ‎tissue interventions like muscle releases and/or transfers, which can rectify this deformity.‎‏ ‏The ‎current study aimed to present the clinical and radiological outcome after arthroscopic release of ‎shoulder internal rotation contracture in cases of brachial plexus injury during birth. Methods: The ‎current study was done in Zagazig University hospitals and had been included thirty-five participants ‎presented by brachial plexus injury since delivery associated with shoulder internal rotation ‎contracture with subluxation of the humeral head. Results: Mallet score; improved as the median of ‎pre-operative Mallet score was 11 (2) and significantly increased to 16 (3) at the post-operative ‎follow up, external rotation; improved as the median of pre-operative external rotation was 2 (1) and ‎increased to 4 (1) post-operatively (P<0.001). Increase in elevation; as median of pre-operative ‎elevation was 3 (1) and increased to 4 (1) post-operatively (P=0.003). Conclusion: The optimal time ‎to do the arthroscopic release is before the child reaches two years old in order to achieve the greatest ‎range of motion improvement of shoulder and to prevent additional bone alterations such as glenoid ‎retroversion or displacement of the humeral head posteriorly, according to our perspective. ‎