Lee Ellen Y, Shin Alexander Y, Shaughnessy William J, Pulos Nicholas
Department of Orthopaedic Surgery, Mayo Clinic, Rochester, MN.
Department of Hand and Reconstructive Microsurgery, National University Health System, Singapore.
J Pediatr Orthop. 2025 Aug 1;45(7):e631-e636. doi: 10.1097/BPO.0000000000002952. Epub 2025 Jul 1.
Secondary shoulder deformities are the most frequent sequelae of upper trunk-type brachial plexus birth injury (BPBI). Coracoid process dysplasia was recently described as being associated with glenoid retroversion and was recognized to block successful humeral head relocation. There are little to no reports on coracoid process deformity causing anterior shoulder pain. Our hypothesis is that coracoid process impingement causes anterior shoulder pain in BPBI, which is relieved by coracoid excision. This study presents the short-term results of this new technique in BPBI patients.
A retrospective review identified BPBI patients who underwent coracoid excision from 2000 to 2022. Indications for this procedure include BPBI patients with anterior shoulder pain limiting the range of motion, localized tenderness over a prominent coracoid process, a dysplastic coracoid process seen on imaging, and persistent pain despite activity modification, medication, and therapy. Patient characteristics, preoperative shoulder pain score, range of motion, degree of glenohumeral subluxation, patient-reported outcomes measurement information system (PROMIS) scores for pain interference, and physical and upper extremity function were collected from chart review. Postoperative pain scores, range of motion, and PROMIS scores were collected at an average of 1 year after excision.
Five upper trunk BPBI patients, ages 10 to 25 years old, with anterior shoulder pain underwent coracoid excision. All had statistically significant pain relief from 6.5-8.5/10 before to 0-3/10 after the procedure. Forward flexion and external rotation improved by an average of 18 degrees. The pain interference score decreased by 25%. There was a 33% improvement in physical function scores and a 31% increase in upper extremity function scores. No complications or recurrence were observed at 7.5 months to 1 year and 7 months after surgery.
Coracoid excision is a simple procedure that can relieve localized shoulder pain caused by coracoid impingement in adolescent/adult BPBI. Continued follow-up of all patients will be undertaken to determine long-term recurrence rates and complications.
Level IV.
继发性肩部畸形是上干型臂丛神经产伤（BPBI）最常见的后遗症。喙突发育异常最近被描述为与肩胛盂后倾相关，并被认为会阻碍肱骨头成功复位。关于喙突畸形导致前肩部疼痛的报道极少。我们的假设是，喙突撞击会导致BPBI患者出现前肩部疼痛，而喙突切除术可缓解这种疼痛。本研究展示了这项新技术在BPBI患者中的短期结果。
一项回顾性研究确定了2000年至2022年期间接受喙突切除术的BPBI患者。该手术的适应症包括因前肩部疼痛而限制活动范围的BPBI患者、突出喙突上的局限性压痛、影像学上显示的发育异常喙突，以及尽管改变活动方式、使用药物和接受治疗仍持续疼痛的患者。通过病历审查收集患者特征、术前肩部疼痛评分、活动范围、盂肱关节半脱位程度、患者报告的疼痛干扰结局测量信息系统（PROMIS）评分以及身体和上肢功能评分。术后疼痛评分、活动范围和PROMIS评分在切除术后平均1年收集。
5例年龄在10至25岁之间、有前肩部疼痛的上干BPBI患者接受了喙突切除术。所有患者术前疼痛评分平均为6.5 - 8.5/10，术后降至0 - 3/10，疼痛缓解具有统计学意义。前屈和外旋平均改善了18度。疼痛干扰评分下降了25%。身体功能评分提高了33%，上肢功能评分增加了31%。术后7.5个月至1年以及7个月时未观察到并发症或复发情况。
喙突切除术是一种简单的手术，可缓解青少年/成人BPBI中由喙突撞击引起的确局限性肩部疼痛。将对所有患者进行持续随访，以确定长期复发率和并发症情况。
四级
