PeripheralNerves.com

Obstetric Brachial Plexus Palsy (OBPP) 

Sub-topics

Introduction / Aetiology / Classification / Clinical Features / 

Diagnosis (Electrophysiology)  / Prognosis / Treatment / Surgery / 

Results / Late Effects of OBPP.

Late effects of OBPP

Fixed deformity of shoulder results mostly from internal rotation contracture and partly from the muscle paralysis and imbalance of the shoulder muscles. The abductors and lateral rotators of the shoulder are innervated by the 5th and 6th nerves. The subscapularis is on the other hand can be spared because of it's innervation from the 7th and 8th nerves. 

The main effects are medial rotation contracture, posterior shoulder subluxation, posterior shoulder dislocation and complex subluxation and dislocation. The coracobrachialis muscle is contracted therefore the coracoid process is elongated, the head of the humerus is retroverted in it's axis (facing posteriorly) and there are changes in the structure of the glenoid see X-rays of dislocated shoulder as compared to normal X-rays.

Treatment for late effects of OBPP

The best treatment is prevention by physiotherapy as outlined in the section on Treatment of OBPP. Twenty-five percent of the children will still require surgery for some of the late effects of OBPP. These can range from soft tissue to boney procedures. 

1. Anterior release of shoulder and subscapularis z-lengthening for the mildest form of medial rotation contracture.

2. Medial rotation osteotomy to correct humeral retroversion. A cut/ osteotomy is made and the head of humerus is twisted into a corrected position. This position is maintained with plate and screws. The child is also immobilised in plaster or brace as shown below.

X-ray of medial rotation osteotomy            Brace after surgery        (Click for a larger image)

    3.    In advanced deformity, a combination of above procedures with bone grafting to the back of the scapula so as to prevent further dislocation and reconstruct the glenoid.

Results of late OBPP surgery

Without surgical intervention in severe cases, the function of the shoulder is compromised. However surgery to restore the anatomy of the shoulder joint has revealed remarkable remodeling to give lasting significant improvement in function.

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Last modified: July 02, 2002