Release Operation for Internal Rotation Contracture of the Shoulder in Obstetric Birth Palsy in Children

Abstract

[Purpose] We report the results of the release operation for internal rotation contracture of the shoulder in obstetric birth palsy in children.
[Surgical procedure]Under general anesthesia, an anterior approach to the shoulder was used. The elongated coracoid process was resected and the contractured subscapularis muscle was elongated with a Z-plasty technique. The shoulder was immobilized for 6 weeks with the arm in full external rotation. This method was applied in two cases.
Case 1: A 3-year-old boy. The left upper type. The boy could hardly flex his fingers, wrist, or elbow. The ROMs of the shoulder were 90in flexion and in abduction. However, internal rotation contracture was present and passive external rotation was -30°. X-rays revealed that the glenoid cavity was shallow, the humeral head was deformed and the coracoid process was slightly elongated downward.
Case 2: A 10-year-old girl. The left upper type. Her hand and wrist were quite normal, but extension of her elbow was restricted to -20. The ROMs of the shoulder were 130in flexion and 140in aduction, however, there was a internal rotation contracture present and passive external rotation was -5°. X -ray revealed that the glenoid cavity was shallow, the humeral head was deformed and the coracoid process was extremely elongated- downward.
[Result]In Case 1,1 year post-operatively, active external rotation of the shoulder is possible to 15° and passive external rotation is possible to 45°. Hand function itself has improved to some extent. In case 2,6 months post-operatively, active external rotation of the shoulder is possible to 15° and passive external rotation is possible to 30°.
[Conclusion]The ROMs of the shoulder, hand reach and hand function have improved and eventually the ADL improved in both cases.