Shoulder reconstruction in patients with chronic brachial plexus birth palsy. A case control study.

Patients with chronic brachial plexus birth palsy and persistent peripheral neurologic deficits frequently have problems related to their shoulder. Specifically, internal rotation and adduction contractures develop because of the loss of muscle balance about the glenohumeral joint. With time, progressive and predictable deformity of the glenohumeral joint occurs. The authors reviewed their results in treating patients with persistent functional deficits with either soft tissue procedures (tendon transfers and muscle releases) or rotational humeral osteotomies based on criteria incorporating patient age and degree of glenohumeral deformity. Patients in each group were evaluated prospectively and compared with each other. In all cases, patients in both groups experienced substantial improvements in global shoulder function. In the patients in the tendon transfer group, global Mallet scores improved from an average of 9.5 to 15.6. Patients undergoing humeral osteotomies also had improvements in global Mallet score from an average of 9.5 to 15.1. This study confirms that both operations, when appropriately applied, will predictably improve shoulder function.