Magnetic Resonance Imaging and Clinical Findings Before and After Tendon Transfers About the Shoulder in Children With Residual Brachial Plexus Birth Palsy: A 3-year Follow-up Study

Background: Incomplete recovery after brachial plexus birth palsy often results in decreased movement and muscle imbalance about the shoulder, as rotator cuff and deltoid innervation are incomplete. Tendon transfers redistribute the forces about the joint and were thought to promote glenohumeral joint remodeling. Early reports, however, indicate limited ability to affect joint configuration. Our previous report and conclusions to this regard were based upon short follow-up. The purpose of this study was to assess the magnetic resonance imaging and clinical outcome after tendon transfers about the shoulder in children with residual brachial plexus birth palsy. Methods: This was a retrospective chart review of 24 children who underwent transfer of the latissimus dorsi and teres major to the posterior rotator cuff with or without concomitant musculotendinous lengthenings. Follow-up magnetic resonance imaging data were available for all subjects at 1-year postsurgery and 19 subjects at 3-year follow-up. Results: Preoperative average glenoid version was -25 +/- 13 degrees (range, -51- -11 degrees). Compared with preoperative version, there was no statistical difference at 1 year (-25 +/- 14 degrees; range, -56- -7 degrees; P=1.00) or at 3 years (-22 +/- 11 degrees; range, -54- -8 degrees; P=1.00). Preoperative average percent of humeral head anterior was 29% +/- 15% (range, 0%-44%). Compared with preoperative percent of humeral head anterior, there was no statistical difference at 1 year (28% +/- 16%; range, 0%-52%; P=1.00) or at 3 years (35% +/- 13%; range, 0%-51%; P=0.32). Clinical evaluation showed significant improvements (P<0.05) in preoperative (-3 +/- 21) to 1-year (18 +/- 32) external rotation Significant improvements in abduction were found from 116 +/- 39 degrees before surgery to 151 +/- 30 degrees and 161 +/- 20 degrees at 1 and 3 years after surgery, respectively. Conclusions: These results demonstrate that tendon transfers improve overall shoulder motion, but do not reduce humeral head subluxation or improve glenohumeral joint realignment. Level of Evidence: Level IV.