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. 2016 May-Jun;49(3):144-9.
doi: 10.1590/0100-3984.2015.0039.

Imaging assessment of glenohumeral dysplasia secondary to brachial plexus birth palsy

Francisco Abaete Chagas-Neto  1 , Vitor Faeda Dalto  2 , Michel Daoud Crema  3 , Peter M Waters  4 , Everaldo Gregio-Junior  5 , Nilton Mazzer  6 , Marcello Henrique Nogueira-Barbosa  7
Affiliations

Imaging assessment of glenohumeral dysplasia secondary to brachial plexus birth palsy

Francisco Abaete Chagas-Neto et al. Radiol Bras. 2016 May-Jun.

Abstract
in English, Portuguese

Objective: To assess imaging parameters related to the morphology of the glenohumeral joint in children with unilateral brachial plexus birth palsy (BPBP), in comparison with those obtained for healthy shoulders.

Materials and methods: We conducted a retrospective search for cases of unilateral BPBP diagnosed at our facility. Only patients with a clinical diagnosis of unilateral BPBP were included, and the final study sample consisted of 10 consecutive patients who were assessed with cross-sectional imaging. The glenoid version, the translation of the humeral head, and the degrees of glenohumeral dysplasia were assessed.

Results: The mean diameter of the affected humeral heads was 1.93 cm, compared with 2.33 cm for those of the normal limbs. In two cases, there was no significant posterior displacement of the humeral head, five cases showed posterior subluxation of the humeral head, and the remaining three cases showed total luxation of the humeral head. The mean glenoid version angle of the affected limbs (90-α) was -9.6º, versus +1.6º for the normal, contralateral limbs.

Conclusion: The main deformities found in this study were BPBP-associated retroversion of the glenoid cavity, developmental delay of the humeral head, and posterior translation of the humeral head.

Objetivo: Avaliar os parâmetros de imagem relacionados com a morfologia da articulação glenoumeral em crianças com paralisia obstétrica do plexo braquial (POPB) unilateral, comparando-os com os observados em ombros saudáveis.

Materiais e métodos: Foi realizada uma busca retrospectiva de casos de POPB unilateral diagnosticados em nossa instituição. Somente foram incluídos os pacientes com diagnóstico clínico de POPB unilateral, e a amostra final do estudo consistiu em 10 pacientes consecutivos avaliados por meio de imagens transversais. Foram avaliados a retroversão da cavidade glenoide, a translação da cabeça do úmero e o grau de displasia glenoumeral.

Resultados: A média do diâmetro da cabeça do úmero foi 1,93 cm nos membros afetados e 2,33 cm nos membros normais. Em dois casos, não houve deslocamento posterior significativo da cabeça do úmero, cinco casos apresentaram subluxação posterior da cabeça do úmero, e os três casos restantes apresentaram luxação total da cabeça do úmero. A média do ângulo de retroversão glenoide dos membros afetados (90-α) foi -9,6º, ao passo que a dos membros contralaterais normais foi +1,6º.

Conclusão: As principais deformidades encontradas neste estudo foram retroversão da cavidade glenoide relacionada com POPB, atraso no desenvolvimento da cabeça do úmero e translação posterior da cabeça do úmero.

Keywords: Birth injuries/complications; Brachial plexus neuropathies/complications; Humeral head/abnormalities; Joint diseases/diagnosis; Shoulder dislocation/diagnosis; Tomography.

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Figures

Figure 1
Figure 1
A: Schematic drawing of glenoid version (90-α) and humeral head translation measurement methods. The percentage of the humeral head anterior to the scapular line (PHHA) was measured according to the formula PHHA = AB/AC × 100. B: Axial computed tomography scan of the glenohumeral joint, corresponding to an illustrative case.
Figure 2
Figure 2
Sample distribution regarding the diameter of the humeral head (cm) on the affected side and unaffected (contralateral) side.
Figure 3
Figure 3
Sample distribution regarding the percentage of the humeral head anterior to the scapular line. A reference range for normality would be 40-50%.
Figure 4
Figure 4
Glenoid version distribution on the affected side and unaffected (contralateral) side.
Figure 5
Figure 5
Illustrative example of glenohumeral dysplasia shown in an axial section computed tomography scan. The right glenohumeral joint was dysplastic and the left side was unaffected. The angles of retroversion were measured as described by Friedman et al.(6). Right side: α = 110º; version angle: 90-110º = -20º, interpreted as glenoid cavity retroversion. Left side: α = 89º; version angle: 90-89º = +1º, interpreted as glenoid cavity anteversion (normal contralateral).
Figure 6
Figure 6
Examples of three-dimensional volume rendering of computed tomography images acquired from two different patients. A: Three-dimensional reconstruction, posterior view. Female patient, 12 years old, history of high obstetric traumatic brachial plexus injury on the right. Note the elevation of the right scapula (arrow) and reduction of right scapula size. B: Posterior view. Volume rendering with skin referential of a 4-year-old male patient with obstetric brachial plexus injury on the left side. Note the elevation of the left scapula, reduced size of the humeral head (arrowheads), and positioning of the left limb (maintained in abduction and internal rotation).
See this image and copyright information in PMC

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