Shoulder functional outcome after latissimus dorsi muscle transfer and subscapularis muscle release in children with obstetrical brachial plexus palsy

الملخص EN

Objective: To evaluate the shoulder functional outcome in children with obstetrical brachial plexus palsy after performing latissimus dorsi muscle transfer and subscapularis muscle release.

Methods: this is a retrospective analysis to fifty patients with 52 shoulders underwent latissimus dorsi muscle transfer and subscapularis muscle release for obstetrical brachial plexus palsy, between June 2008 and April 2012.

Reviewing patient’s files and pre-operative videos.

Mallet scoring system was used to evaluate the shoulder functional changes.

Results: Fifty children with fifty two shoulders with a ranging age between 18 months up to 13 years were involved in this study, 1:1 male to female ratio, the average birth weight was 3.89KG, the brachial plexus extent of injury were ranging from upper injury 80% to total palsy 20%.

Regarding the affected limb the right side involvement was 60% the left side 36% and bilateral involvement was 4%.there is significant difference in the global upper limb function between younger age group(below five years) when compare to older age group(above five years of age).

Five active ranges of motion around the shoulder joint involved in the injury were analyzed with the following functional outcome improvement: Global Abduction 46.6%, Global External Rotation 62.9%, Hand to neck 49%, Hand to spine 53.3%, Hand to mouth 57.2% Conclusion: we found that this type of surgery improves the global function of the upper limb in patients with obstetrical brachial plexus palsy, this improvement become less remarkable in older children(>5years of age).

And the majority of patients and their families were satisfied by the achieved results.