Arthroscopic release of the Subscapularis Muscle and open transfer of the Latissimus Dorsi Muscle improves daily function in Obstetrical Brachial Plexus Lesions.
Nielsen KD, Frich LH, Jepsen S, Simesen K
Orthopaedic Dept., Odense University Hospital, Odense, Denmark
Introduction The management of brachial plexus birth palsies (BPBP) remains a vexing problem. A fixed contracture often develops over time and has a deleterious affect on glenohumeral (GH) development.. The purpos of this study was to evaluate the clinical outcome after arthroscopic release of the Subscapeularis tendon, and open transfer of the Latissimus Dorsi muscle.
Methods. 21 patients (9 boys), aged 5,7 years (0 – 10) were operated on in the period of 2004 – 2007. Thirteen (13) patients had an arthroscopic release with partial tenotomy of the Subscapularis and decompression of the Coracoid, and 8 patients also had a
concomitant open transfer of the Latissimus Dorsi muscle. All patients were evaluated according to the Mallet score (a scale from 5 – 15). Additionally the active external rotation of the adducted upper arm before and after the arthroscopic procedure was evaluated. Follow-up period was 23-66 months.
Results. Arthroscopic release resulted in an improved external rotation of mean 41°
(24.9°-58.1°) (95% cfi). The gain in external rotation when arthroscopic release was combined with Latissimus Dorsi transfer was 38.1° (12.5°-63.8°).The overall Mallet score improved from mean 9.2 (8.1-10.3) to 12.3 (11.3-12.4). No pre- or postoperative
complications were recorded.
Conclusion. Our technique of partial tenotomy of the Subscapularis tendon and rotator interval decompression, gives results comparable to open release techniques, however, with a much lower morbidity. The improvements in Mallet score and active external rotation was significant in both treatment groups. The contribution from the Latissimus Dorsi transfer remains a problem and the indication of muscle transfers in OBPL demands further investigation.