Shoulder and Elbow Function in Children With Erbs Palsy - PDF document

Shoulder and Elbow Function in Children With Erb's Palsy Price, Michael Tidwell, and John A.I. Grossman children who sustain birth injuries to the brachial plexus suffer significant functional limitations due to various sequelae affecting the shoulder and elbow or forearm. The maintenance of full passive mobility during the period of neurological recovery is essential for normal joint development. Early surgical correction of shoulder contractures and subluxations reduces permanent deformity. Reconstruction of forearm rotation contractures significantly improves the appearance and use of the extremity for many basic 1927, Sever 1 published an evaluation of 1,100 consecutive patients with b

rachial plexus birth injuries. He saw no difference in outcome between the operative and nonoperative patients. As a result, treatment of this condition remained largely nonop- erative for more than 50 years, with a "wait and see" management philosophy prevailing. Most chil- dren with brachial plexus birth injuries were able to adapt to the Division of Pediatric Orthopedic Surgery, St. Luke's Roosevelt Hospital Center, New York, of treatment is important. Because most children realize neurological recovery over a num- ber of years) the delay in normal muscle function and the presence of muscle imbalance across any upper extremity joint can have OF MUSCULOSKELETAL INJURY an infant in the ne

wborn nursery is noted to lack movement of the upper extremity due to a suspected nerve injury, the examination must also determine the presence of a non-neurological in- jury. Birth trauma in Pediatric Neurology, 7, No 1 (March), 2000: pp 44-51 SHOULDER AND ELBOW FUNCTION ERB'S PALSY 45 healing has or elbow neurological recovery, muscle imbalance shoulder and it is by MRI reduction with fracture or and no the natural against the is to and the essential condition external rotation and the shoulder relaxes thereby allowing unable to located joint, avoid joint PRICE, TIDWELL, AND GROSSMAN external rotators the special educate parents caregiver must and the does not anterior shoulder therapis

t and exercises designed are de- release through transferred around external rotators agree with soft-tissue contractures and shoulder chronic shoulder classically associated with be improved SHOULDER AND ERB'S PALSY Schematic demonstrating direction the scapula high on s ) transfer leaves appearance. In gaining abduction some bulk AND FOREARM children with contracture often or absent biceps it is or nighttime use associated pronation as well. at least present early pronation or gives an PRICE, TIDWELL, AND GROSSMAN they alone are not addition to Fig 4. and B) Permanent, fixed deformity in internal rotation in a teenage (The cast unrelated scaphoid fracture.) (C) External rotational with ri

gid plate fixation allows immediate postoperative mobili- E) Long-term result. it tends ELBOW FUNCTION we have and impairs 80-20 80-0 80-80 80-80 80-20 80-10 80-60 80-50 80-45 80-0 80-80 80-45 80-45 80-10 80-80 80-45 12/F 80-80 80-0 80-80 80-45 80-10 80-0 PT/lacertus/brachioradialis/flexor lengthening/sub- 80-80 80-45 80-10 80-0 ECRB 80-75 80-10 80-20 80-10 80-80 80-50 80-15 80-0 80-80 80-40 PRICE, TIDWELL, AND GROSSMAN Fig 5. (A) Unsightly supination deformity of the severe functional impairment limb length discrepancy. Following biceps rerouting flexion and radial carpal the results are or pronation Table 2. Results Parental Questionnaire Following Surgical Forearm Rotation Deformities in

Patients Obstetric Brachial Plexus Injury to other 20 1 (N = 9), (N = AND ELBOW FUNCTION IN ERB'S PALSY 51 treated over a 5-year period, only 1 child realized no significant improvement (Table 2). In all children with musculoskeletal sequelae following an obstetrical brachial plexus injury, careful and complete evaluation of the disabilities and deformities must be performed jointly by the surgeon and therapist. The use of advanced imag- ing and neurophysiologic techniques is often a valuable supplement. In most children with shoul- der and elbow-forearm deformities, a properly selected surgical procedure(s) significantly im- proves the form and function of the injured extremity. REFEREN

CES 1. Sever JW: Obstetric paralysis: Report of eleven hundred cases. JAMA 85:1862-1865, 1925 2. Sundholm LK, Eliasson AC, Forssberg H: Obstetric bra- chial plexus injuries: Assessment protocol and functional out- come at age 5 years. Dev Med Child Neuro140:4-11, 1998 3. Rossi LN, Vassella F, Mumenthaler M: Obstetrical lesions of the brachial plexus: Natural history in 34 personal cases. Eur Neuro121:1-7, 1982 4. Goddard N: The development of the proximal humerus in the neontate, in Tubiana R (ed): The Hand (vol 3). Philadelphia, PA, WB Saunders, 1993, pp 624-631 5. Price AE, Grossman JAI: A management approach for secondary shoulder and forearm deformities following obstetri- cal brachial p

lexus injury. Hand Clin 11:607-617, 1995 6. Pearl ML, Edgerton BW: Glenoid deformity secondary to brachial plexus birth palsy. J Bone Joint Surg 80A:659-667, 1998 7. Waters PM, Smith GR, Jaramillo D: Glenohumeral defor- mity secondary to brachial plexus birth palsy. J Bone Joint Surg 80A:668-677, 1998 8. Aitken J: Deformity of the elbow joint as a sequel to Erb's obstetrical paralysis. J Bone Joint Surg 34B:352, 1952 9. Liggio FJ, Tham S, Price A, et al: Outcome of surgical treatment for forearm pronation deformities in children with obstetric brachial plexus injuries. J Hand Surg 24B:43-45, 1999 10. Zancolli EA: Paralytic supination conUacture of the forearm. J Bone Joint Surg 49A: 1275-128