Arthroscopic treatment of internal rotation contracture and glenohumeral dysplasia in children with brachial plexus birth palsy

Background: The purpose of the study was to assess the ability of arthroscopic anterior release, +/- tendon transfers to maintain shoulder joint alignment in children with brachial plexus palsy, and to assess their outcome after arthroscopic reduction. Methods: Forty-four patients underwent arthroscopic release, +/- tendon transfers to realign a dysplastic glenohumeral joint in children with brachial plexus palsy. Twenty-eight children underwent isolated release and 16 children underwent concomitant tendon transfers. MRI and clinical measurements were used to assess outcome at 1-year follow-up. Results: There was a significant improvement (P<.001) in both retroversion from -34 (+/- 15) to -19 (+/- 13), and percentage of the humeral head anterior to the middle of the glenoid fossa (PHHA) from 19% (12%) to 33% (+/- 12%), at 1 year. Passive external rotation increased from -26 (+/- 20) degrees to 47 (+/- 17) degrees (P<.001). Active elevation increased from 112 (+/- 28) degrees to 130 (+/- 38) (P=.008) degrees. Patients that underwent tendon transfers obtained greater active elevation, 147 (+/- 9) degrees compared to 119 (+/- 6) degrees. Mallet aggregate and domain scores also demonstrated statistically significant improvements. Conclusions: Our results after arthroscopic release +/- tendon transfers are encouraging with improvements in joint alignment and clinical evaluations following surgery. The clinical improvements paralleled the MRI corrections. Importantly, superior outcomes were associated with better preoperative clinical and MRI status. This indicates that early recognition of glenohumeral dysplasia and timely intervention results in better shoulder motion and improved joint alignment.