Arthroscopic Release Of Shoulder Internal Rotation Contracture In Brachial Plexus Palsy

Obstetrical brachial plexus paralysis (OBPP) refers to complete or partial injury of the brachial plexus produced at the time of birth. OBPP involves most commonly the upper cervical roots (C5, C6) resulting in muscle imbalance between internal and external rotators of the shoulder . Although the majority of the patients (80-90%) recover spontaneously, some have a remaining imbalance causing severe functional impairment . In addition to diminished function, prolonged muscle contractures result in bony deformities in both the glenoid and proximal humerus. Internal rotation contractures due to external rotational weakness are the most common deformity in OBPP. Contracture release, tendon transfers, and rotational osteotomies are surgical methods used, depending on the level of deformity and the patient's age. To achieve functional external rotation of the arm, contracted structures should be released first. Currently, there is a lack of consensus on which procedures over the best outcome for mobility and function, and what are the precise indications for each type of surgery. There is also a large variation of practice between centers