Arthroscopic treatment for internal contracture of the shoulder secondary to brachial plexus birth palsy: report of a case series and review of the literature

Abstract

Objectives: Internal rotation contracture of the shoulder is a common complication in children with brachial plexus birth palsy (BPBP), causing early functional limitation and glenohumeral dysplasia. Arthroscopic arthrolysis has recently been described as a treatment for the sequelae of this condition.

Methods: Review of five patients who underwent shoulder arthroscopy by anterior capsulotomy and partial tenotomy of the subscapularis. Both clinical and functional assessments were made (Mallet classification). Perioperative monitoring was conducted using MRI and ultrasound.

Results: The diagnosis was BPBP of the upper trunks (C5-C6) in all five patients (four girls and one boy, with a mean age of 2.8 years). The mean follow-up period was 19.9 months (range 12.8-39.9). The mean improvement obtained was 3.8 points according to the Mallet classification, 48° of external rotation and 54° of shoulder abduction.

Conclusions: Arthroscopic arthrolysis of the shoulder in children with BPBP sequelae (internal rotation contractures) is a safe and effective procedure that produces clinical improvement in function and mobility.

Keywords: Brachial plexus disorder; Obstetric brachial plexus palsy; Shoulder arthroscopy; Shoulder contracture.