Tenomyoplastic procedures to improve shoulder function in the treatment of perinatal brachial plexus palsy.

BACKGROUND: A contracture of the shoulder joint in the course of perinatal brachial plexus palsy significantly affects the function of the upper limb as a whole. The aim of this paper is to present the authors' experience in surgical procedures carried out to improve shoulder joint function impaired as a result of perinatal brachial plexus palsy and evaluate the treatment outcomes. MATERIAL AND METHODS: The study involved 36 patients who underwent 37 tenomyoplastic procedures (subscapular release, teres major transfer, transfer of a portion of the trapezius). Pre- and postoperative shoulder joint function was assessed with the Gilbert scale. RESULTS: Surgical release of the subscapular muscle improved shoulder function in all patients, usually by 1 degree in the Gilbert scale. Teres major transfer improved shoulder function in all 4 patients (grade IV - 3 children, grade V - 1 child). One patient benefited from tenomyoplasty involving the trapezius. CONCLUSIONS: 1. Indications for tenomyoplasty procedures in the region of the shoulder joint may be present both in children who had previously undergone microsurgery and in those in whom rehabilitation had led to a good outcome of perinatal brachial plexus palsy. 2. The fact that most patients improved following tenomyoplastic procedures justifies their advisability. A visible functional improvement of the upper limb can be achieved with a relatively low risk of complications.