Evidence-Based Treatment of Glenohumeral Dysplasia Caused by Obstetric Brachial Plexus Injuries
Glenohumeral dysplasia is a disorder that occurs in the growing skeleton following a partial denervation of the muscles around the shoulder due to an obstetric brachial plexus palsy. Typically, there is an unopposed internal rotation force resulting in so
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Philip Holland and Matthew F. Nixon
Abstract
Glenohumeral dysplasia is a disorder that occurs in the growing skeleton following a partial denervation of the muscles around the shoulder due to an obstetric brachial plexus palsy. Typically, there is an unopposed internal rotation force resulting in soft tissue and skeletal abnormalities. Management depends on a number of factors, but in the neonate consists of microsurgical reconstruction of the brachial plexus, and in the older child rebalancing of the muscles around the shoulder in the form of tendon transfers. Once skeletal deformities develop these need addressing in the form of reconstruction of the glenoid and humerus. Keywords
Obstetric brachial plexus injury • Erb’s palsy • Glenohumeral dysplasia • Glenoid retroversion • Humeral retroversion • Neurotisation • Tendon transfer • Osteotomy
Introduction
Methodology
Obstetric brachial plexus injuries (OBPI) occur in approximately 0.1–0.4 % of births [1–3]. The risk factors for an OBPI include babies that are large for gestational age, multiparous pregnancies, prolonged labour, difficult deliveries and foetal distress [1, 4]). The incidence of OBPIs is falling which in part is thought to be due to advances in identifying and managing these risk factors [1, 4]). An isolated upper trunk injury is the most common OBPI [4]. This causes denervation of some of the shoulder muscles leading to glenohumeral internal rotation contractures and dysplasia. Hand function is often well preserved. The aim of shoulder surgery is to prevent and reverse the development of glenohumeral contractures and dysplasia. This chapter discusses the surgical management of the shoulder following isolated upper trunk OBPIs with or without involvement of the middle trunk.
The Medline, PubMed, and Google Scholar databases were searched to identify articles with the key term “obstetric brachial plexus injury.” From the articles identified only articles which included one or more of the terms surgery, pathology, classification or shoulder in the title or abstract were included. Trial registries and the Internet were also searched. The references of articles identified were reviewed. Articles were graded according to the Oxford Evidence Based Grading System.
P. Holland Countess of Chester Hospital NHS Foundation Trust, Chester, UK e-mail: [email protected]
Patterns of Nerve Injury
M.F. Nixon (*) Royal Manchester Children’s Hospital, Manchester, UK e-mail: [email protected]
What Is the Natural History of Obpis? The levels of evidence for published work included in this chapter ranged from II to V; there was no level I evidence.
The first published descriptions of OBPIs were by Erb, Duchenne and Klumpke (Duchenne 1872 Erb 1874 Klumpke 1885). The terms Erbs Palsy and Klumpkes Palsy are
© Springer International Publishing Switzerland 2017 S. Alshryda et al. (eds.), Paediatric Orthopaedics, DOI 10.1007/978-3-319-41142-2_31
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commonly used in clinical practice to describe isolated upper trunk injuries and isolated lower trunk i
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