ISSN: 2640-2734
Authors: Hassa E*, Danisman M, Basaran T, Leblebicioglu AG and Doral MN
Objective: Internal rotation contracture of the shoulder area developing on the follow-up of pediatric patients with obstetric brachial plexus palsy (OBPP) can lead to glenoidal and humeral head dysplasia and glenohumeral joint (GHJ) posterior dislocation. OBPP patients accompanied by the shoulder area problems and made early surgical intervention, long-term effects (> 2 years) of the balance between internal and external rotator muscle groups provided with tendon transfers and reduction of the joint on GHJ remodelling and on periscapular muscle development have been evaluated through magnetic resonance imaging (MRI) guided. Patients and methods: 14 patients with OBPP having had secondary shoulder surgery were placed retrospectively under examination to be evaluated in terms of GHJ remodelling, volumetric changes of internal (subscapularis) and external rotator muscles (infraspinatus and teres minor) groups. Current MRI of healthy sides is assessed in order to assess whether changes on patient group having preoperative and postoperative shoulder MR reviews of side with palsy are at the close rate to the healthy side. Proximal humeral head anterior ratio (PHHA) has been used for the assessment of subluxation in MRI reviews. Measured glenoid version (GV) changes have been examined in terms of seeing responses of glenoid dysplasia to surgical treatment and elliptical index (EI) changes have also been examined in terms of seeing responses of humeral head dysplasia to surgical treatment. Subscapularis (SS) and external rotators (ER) muscle groups have also been examined into areas in MRI scans and change amount has been determined by converting these values into volumetric data. Results: GV and ER values from examined parametric changes have shown statistically significant (p <0.05) change as being very close to healthy shoulder side values. In terms of last GV and ER values obtained, statistically significant difference couldn’t be found between the shoulder values of the side with palsy and the shoulder values of the healthy side. Namely, even though significant and positive changes after the surgery have been observed in terms of PHHA and SS, these values cannot catch the healthy side values. The most negative results in the study have been obtained in ER changes. Any statistically significant changes haven’t been observed in terms of ER volumetric changes after surgery. Conclusion: In the cases with OBPP accompanied by the shoulder problems it has been found that significant osseous remodelling has been provided with surgery of early secondary shoulder region in long-term follow-up
Keywords: OBPP; Brakial Plexus Palsy; Glenoidal and Humeral Head Dysplasia
