TITLE

Correlation of Radiographic Muscle Cross-Sectional Area with Glenohumeral Deformity in Children with Brachial Plexus Birth Palsy

AUTHOR(S)
Waters, Peter M.; Monica, James T.; Earp, Brandon E.; Zurakowski, David; Bae, Donald S.
PUB. DATE
October 2009
SOURCE
Journal of Bone & Joint Surgery, American Volume;Oct2009, Vol. 91-A Issue 10, p2367
SOURCE TYPE
Academic Journal
DOC. TYPE
Article
ABSTRACT
Background: Muscle imbalance about the shoulder in children with persistent brachial plexus birth palsy is thought to contribute to glenohumeral joint deformity. We quantified cross-sectional areas of the internal and external rotator muscles in the shoulder by magnetic resonance imaging in patients with chronic brachial plexopathy and the correlation between these muscle cross-sectional area ratios and glenohumeral deformity. The purposes of this investigation were to evaluate differences in the ratios between affected and unaffected shoulders in the same individual and to assess whether an increased internal to external rotator muscle cross-sectional area correlated with greater glenohumeral deformity. Methods: This cohort study consisted of magnetic resonance imaging of seventy-four patients with chronic neuropathic changes about the shoulder from brachial plexus birth palsy. There were at least nine patients with scans available for each of the five classified subtypes of glenohumeral deformity: type I (fifteen patients), type II (seventeen), type III (seventeen), type IV (sixteen), and type V (nine). Cross-sectional areas of the pectoralis major, teres minor-infraspinatus (external rotators), and subscapularis muscles were measured. The supraspinatus muscle cross-sectional area could not be reliably measured. The ratio of subscapularis to external rotators, the ratio of pectoralis major to external rotators, and the compound ratio of subscapularis and pectoralis major to external rotators were compared with the severity of the glenohumeral deformity. Passive range of motion, Mallet and Toronto clinical scores, and Narakas type were also compared with the severity of the glenohumeral deformity and the muscle cross-sectional area measurements. Results: Muscle cross-sectional area ratios were significantly correlated with glenohumeral deformity type. The mean ratio of pectoralis major to external rotators for affected shoulders over all deformity types compared with that for unaffected shoulders was significantly increased by 30% (p < 0.001); the mean ratio for subscapularis and pectoralis major to external rotators, by 19% (p = 0.015), and the mean ratio for subscapularis to external rotators, by 10% (p = 0.008). There was a significant increase in the ratio of pectoralis major to external rotators in affected shoulders within each type of deformity. Analysis of variance indicated higher ratios of pectoralis major to external rotator muscle cross-sectional areas in more severe deformity types (p < 0.001). There were significant differences in external rotation measurements with the shoulder at 900 of abduction only among glenohumeral deformity types I, II, and III (p < 0.05). Conclusions: The degree of muscle imbalance between internal and external rotators about the shoulder is measurable by magnetic resonance imaging in children with persistent brachial plexopathy, and the imbalance correlates with the degree of glenohumeral deformity. Our results may provide useful information to guide the timing and the choice of operative intervention in these children.
ACCESSION #
44532494

 

Related Articles

  • Combined Glenoid Anteversion Osteotomy and Tendon Transfers for Brachial Plexus Birth Palsy Early Outcomes. Dodwell, Emily; O'Callaghan, Jamie; Anthony, Alison; Jellicoe, Paul; Shah, Maulin; Curtis, Christine; Clarke, Howard; Hopyan, Sevan // Journal of Bone & Joint Surgery, American Volume;12/5/2012, Vol. 94-A Issue 23, p2145 

    Background: In the setting of severe glenohumeral dysplasia secondary to brachial plexus birth palsy, external rotation osteotomy of the humerus has traditionally been used to transpose the existing arc of shoulder motion to a more functional position. Here we introduce a surgical alternative,...

  • The Early Effects of Tendon Transfers and Open Capsulorrhaphy on Glenohumeral Deformity in Brachial Plexus Birth Palsy. Waters, Peter M.; Bae, Donald S. // Journal of Bone & Joint Surgery, American Volume;Oct2009 Supplement 2, Vol. 91-A Issue 2, p213 

    BACKGROUND: Persistent muscle imbalance and soft-tissue contractures can lead to progressive glenohumeral joint dysplasia in patients with brachial plexus birth palsy. The objective of the present investigation was to determine the effects of tendon transfers and open glenohumeral reduction on...

  • Proximal Humeral Migration in Shoulders with Symptomatic and Asymptomatic Rotator Cuff Tears. Keener, Jay D.; Wei, Anthony S.; Kim, H. Mike; Steger-May, Karen; Yamaguchi, Ken // Journal of Bone & Joint Surgery, American Volume;Jun2009, Vol. 91-A Issue 6, p1405 

    Background: Proximal humeral migration is commonly seen in rotator-cuff-deficient shoulders. The specific effects of the size of the rotator cuff tear and of pain on glenohumeral kinematics have been poorly defined. The purpose of this study was to examine the influences of cuff tear size and...

  • Scapular deformity in obstetric brachial plexus palsy: a new finding. Nath, Rahul K.; Paizi, Melia // Surgical & Radiologic Anatomy;Mar2007, Vol. 29 Issue 2, p133 

    While most obstetric brachial plexus palsy patients recover arm and hand function, the residual nerve weakness leads to muscle imbalances about the shoulder which may cause bony deformities. In this paper we describe abnormalities in the developing scapula and the glenohumeral joint. We...

  • Long-term outcome of accessory nerve to suprascapular nerve transfer in obstetric brachial plexus lesion: functional, morphological, and electrophysiological results. Gmeiner, Matthias; Topakian, Raffi; Göschl, Manuel; Wurm, Sarah; Holzinger, Anita; Ouwerkerk, Willem; Holl, Kurt // Child's Nervous System;Sep2015, Vol. 31 Issue 9, p1541 

    Purpose: An accessory to suprascapular nerve (XIN-SSN) transfer is considered in patients with obstetric brachial plexus lesion who fail to recover active shoulder external rotation. The aim of this study was to evaluate the quality of extraplexal suprascapular nerve neurotization and to perform...

  • Coracoid Abnormalities and Their Relationship with Glenohumeral Deformities in Children with Obstetric Brachial Plexus Injury. Nath, Rahul K.; Mahmooduddin, Faiz; Xiaomei Liu; Wentz, Melissa J.; Humphries, Andrea D. // BMC Musculoskeletal Disorders;2010, Vol. 11, p237 

    Background: Patients with incomplete recovery from obstetric brachial plexus injury (OBPI) usually develop secondary muscle imbalances and bone deformities at the shoulder joint. Considerable efforts have been made to characterize and correct the glenohumeral deformities, and relatively less...

  • Triangle tilt surgery as salvage procedure for failed shoulder surgery in obstetric brachial plexus injury. Nath, Rahul K.; Avila, Meera B.; Karicherla, Priyanka // Pediatric Surgery International;Sep2010, Vol. 26 Issue 9, p913 

    Purpose: The study was conducted to review the effects of triangle tilt surgery in children with OBPI (obstetric brachial plexus injury) who had previously undergone several operative procedures at other hospitals before presenting at our institute. Methods: The study included a group of 48 OBPI...

  • An MRI study on the relations between muscle atrophy, shoulder function and glenohumeral deformity in shoulders of children with obstetric brachial plexus injury. van Gelein Vitringa, Valerie M.; van Kooten, Ed O.; Mullender, Margriet G.; van Doorn-Loogman, Mirjam H.; van der Sluijs, Johannes A. // Journal of Brachial Plexus & Peripheral Nerve Injury;2009, Vol. 4, p1 

    Background: A substantial number of children with an obstetric brachial plexus lesion (OBPL) will develop internal rotation adduction contractures of the shoulder, posterior humeral head subluxations and glenohumeral deformities. Their active shoulder function is generally limited and a recent...

  • Shoulder arthrodesis with a reconstruction plate. Chun, Jae; Byeon, Hwa // International Orthopaedics;Aug2009, Vol. 33 Issue 4, p1025 

    From 1995 to 2005, arthrodesis with a reconstruction plate was performed for eight shoulders. The average follow-up period was 44 months. The indications for shoulder arthrodesis were joint destruction as a sequel of tuberculous arthritis, malignant bone tumour, pyogenic arthritis, failed...

Share

Read the Article

Courtesy of VIRGINIA BEACH PUBLIC LIBRARY AND SYSTEM

Sorry, but this item is not currently available from your library.

Try another library?
Sign out of this library

Other Topics