Open subscapularis release for treatment of internal rotation shoulder contracture in obstetric brachial plexus palsy

• Main Authors: Faisal Hassan Zayed, Ismail Ahmed Hamouda, Ahmed Abdelkreem Ahmed
• Format: Article
• Language: English
• Published: Wolters Kluwer Medknow Publications 2020-01-01
• Series: Al-Azhar Assiut Medical Journal
• Subjects: contracture; subscapularis release; obstetric brachial plexus palsy
• Online Access: http://www.azmj.eg.net/article.asp?issn=1687-1693;year=2020;volume=18;issue=3;spage=254;epage=260;aulast=Zayed

Background One of the most common deformities that results from untreated obstetric brachial plexus palsy (OBPP) is internal rotation shoulder contracture. There are various surgical options for treating this deformity such as muscle release, tendon transfer, and humeral osteotomy. Objective This study expresses the outcome of isolated subscapularis release performed in children with internal rotation shoulder contracture as a consequence of unresolved OBPP. Patients and methods This prospective case series study was conducted in Al Azhar University Hospitals between April 2018 and January 2020. A total of 20 patients aged between 2 and 5 years (mean: 3.2 years) with internal rotation contracture of shoulder residual deformity from OBPP were included. Of the 20 patients, eight were males and 12 were females, and 12 patients were operated on right side and eight were operated on left side, and they were followed up for a period of at least 1 year. Results The mean abduction improved from 61.0±14.1° preoperatively to 103.0±15.25° postoperatively, the mean passive external rotation in adduction improved from −9.5±11.4° preoperatively to 30.5±11.91° postoperatively, the mean active external rotation in abduction improved from 0.5±8.26 preoperatively to 60.25±10.57 postoperatively, and the mean modified mallet score improved from 12.60±1.09 preoperatively to 17.70±1.17 postoperatively. Conclusion Open subscapularis muscle release is a proper starting surgical option in children who present with internal rotation adduction contracture of the shoulder owing to unresolved OBPP.