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Review Discusses Brachial Plexus Birth Palsy Procedure

Shoulder surgery involves tendon transfers to rotator cuff and open glenohumeral reduction

MONDAY, Oct. 19 (HealthDay News) -- The surgical technique for tendon transfers to the rotator cuff and open glenohumeral reduction in patients with joint deformity from brachial plexus birth palsy is discussed in an article in the Oct. 1 supplement to the Journal of Bone & Joint Surgery.

Peter M. Waters, M.D., and Donald S. Bae, M.D., of Children's Hospital Boston, write that candidates for this surgery include brachial plexus birth palsy patients with chronically weak external rotation and abduction, internal rotation contractures, and slight to moderate glenohumeral joint deformity.

The authors warn against overtightening the posterior capsule, as this might restrict shoulder motion and lead to excessive scapulothoracic compensation. The surgeon must also avoid completely releasing the subscapularis and pectoralis major, since this can lead to poor internal rotation strength and subsequent complications. Particular caution must be taken with the axillary nerve and posterior humeral circumflex vessels while finishing the release of the conjoined tendon from the humerus.

"In a recent evaluation of 23 patients with brachial plexus birth palsy and shoulder external rotation weakness, internal rotation contractures, and preexisting glenohumeral joint dysplasia, 19 patients (83 percent) demonstrated radiographic evidence of glenohumeral joint remodeling following tendon transfers, musculotendinous lengthenings, and open glenohumeral joint reduction," the authors write.

At least one author received support for this article from the American Society for Surgery of the Hand and the Pediatric Orthopedic Society of North America.

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