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. 2025 Aug 7.
doi: 10.1007/s00264-025-06630-0. Online ahead of print.

Arthroscopic subscapularis-complex release and conjoint tendon transfer in birth brachial plexus injuries: a case series with evidence-based insights

Aditya K S Gowda  1 , Vivek Singh  2 , Rahul Mishra  3 , Cury Sharma  3 , Vikas Maheshwari  3 , Anil Regmi  3
Affiliations

Arthroscopic subscapularis-complex release and conjoint tendon transfer in birth brachial plexus injuries: a case series with evidence-based insights

Aditya K S Gowda et al. Int Orthop. .

Abstract

Purpose: Shoulder deformities and impaired function in individuals with birth brachial plexus injury (BBPI) are often caused by internal rotator (IR) contractures and abductor weakness, which may progress to glenohumeral dysplasia. Although subscapularis-complex release and tendon transfer is a time-tested procedure, there are controversies regarding the appropriate management of shoulder contractures, especially in preschool children. Therefore, this study examines the efficiency of arthroscopically done progressive controlled release of IR contracture combined with tendon transfer.

Methods: This study included 12 children who presented with shoulder soft tissue contractures and functional impairments, specifically, loss of shoulder abduction and external rotation, but with good deltoid function. They underwent a surgical intervention involving arthroscopy-assisted subscapularis-complex release and conjoint muscle transfer onto the infraspinatus footprint on the humeral head. The evaluation of shoulder function was conducted using the Mallet score system, and the range of motion was measured at preoperative and six month postoperative intervals. Statistical analyses were performed to determine the significance of the outcomes.

Results: The average age of participants was 4.83 ± 2.1 years. Preoperatively, the mean Mallet score was 14.08 ± 1.4, which improved to 23.83 ± 1.2 postoperatively. The average gain in shoulder abduction was 66.4 ± 5.6°, and external rotation improved by 85.4 ± 16.6° at 18 months final follow-up. All patients exhibited improvements in shoulder function, with a significant correlation (p value = 0.037) between Naraka grading, and clinical outcomes.

Conclusion: The combined surgical approach of arthroscopic subscapularis-complex release with conjoint tendon transfer effectively enhances the shoulder function in the studied cohort. Further research and extended follow-up are needed to evaluate the long-term benefits.

Level of evidence: Level IV (Therapeutic case series).

Keywords: Arthroscopic release; Birth brachial plexus injury; Internal rotator contracture; Preschool; Sever-L’Episcopo procedure; Soft tissue procedure.

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Conflict of interest statement

Declarations. Ethical approval: A Prior approval from the institutional ethics committee has been granted for this article. (ref no.- 48/IEC/PGM/2021). Consent to participate: Informed consent has been taken from guardians/parents of patients enrolled for this article. Also, the individual identities of the patients have been concealed to ensure privacy. Competing interests: The authors declare no competing interests.

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References

    1. Van der Looven R, Le Roy L, Tanghe E et al (2020) Risk factors for neonatal brachial plexus palsy: a systematic review and meta-analysis. Dev Med Child Neurol 62:673–683. https://doi.org/10.1111/dmcn.14381 - DOI - PubMed
    1. Koshinski JL, Russo SA, Zlotolow DA (2022) Brachial plexus birth injury: A review of neurology literature assessing variability and current recommendations. Pediatr Neurol 136:35–42. https://doi.org/10.1016/j.pediatrneurol.2022.07.009 - DOI - PubMed
    1. Waters PM, Smith GR, Jaramillo D (1998) Glenohumeral deformity secondary to brachial plexus birth palsy. J Bone Joint Surg Am 80:668–677. https://doi.org/10.2106/00004623-199805000-00007 - DOI - PubMed
    1. Hale HB, Bae DS, Waters PM (2010) Current concepts in the management of brachial plexus birth palsy. J Hand Surg Am 35:322–331. https://doi.org/10.1016/j.jhsa.2009.11.026 - DOI - PubMed
    1. Carlioz H, Brahimi L (1971) [Place of internal disinsertion of the subscapularis muscle in the treatment of obstetric paralysis of the upper limb in children]. Ann Chir Infant 12:159–167 - PubMed

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