Neonatal brachial plexus palsy (NBPP) frequently causes glenohumeral dysplasia. Quantification of this dysplasia on magnetic resonance imaging can determine the need for and the success of nonsurgical or surgical intervention. However, we hypothesize that the variable position of the scapula on the thorax between affected and unaffected shoulders affects dysplasia measurements.
Magnetic resonance imaging studies were analyzed from 19 NBPP patients (ages 0.8–18 years; median, 2.4 years) without prior shoulder surgery. Three reviewers measured the glenoid version angle (GVA) and percentage of humeral head anterior to the midscapular line (PHHA) on standard axial images (“thoracic axial”) and on reformatted axial images aligned perpendicular to the scapular plane (“scapular axial”), which corrects for scapulothoracic position. Scapular tilt and protraction were measured to assess their impact on the difference between thoracic and scapular GVA and PHHA measurements. Intra- and interrater reliability were calculated for GVA and PHHA on both views.
The GVA of the affected shoulder was significantly greater on thoracic than on scapular images, by an average of 5° and as much as 34°. The PHHA was significantly less in the affected shoulders on thoracic than on scapular images, by an average of 5% and as much as 33% of humeral head width. The difference in GVA, but not PHHA, between thoracic and scapular axial images in the affected shoulder correlated with scapular tilt. Unaffected shoulders showed no significant difference in GVA or PHHA between thoracic and scapular axial images. Interrater reliability ranged from fair to substantial and did not differ between thoracic and scapular images.
Thoracic axial images overestimate the severity of glenohumeral dysplasia in NBPP, owing at least in part to the variable position of the scapula on the thorax. This confounding effect must be considered in interpretation of axial quantitative measures of glenohumeral dysplasia in NBPP.
Type of study/level of evidence
To read this article in full you will need to make a payment
Purchase one-time access:Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
One-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:Subscribe to Journal of Hand Surgery
Already a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
- The epidemiology of neonatal brachial plexus palsy in the United States.J Bone Joint Surg Am. 2008; 90: 1258-1264
- Natural history of obstetric brachial plexus palsy: a systematic review.Dev Med Child Neurol. 2004; 46: 138-144
- Correlation of radiographic muscle cross-sectional area with glenohumeral deformity in children with brachial plexus birth palsy.J Bone Joint Surg Am. 2009; 91: 2367-2375
- Posterior shoulder dislocation in infants with neonatal brachial plexus palsy.J Bone Joint Surg Am. 2004; 86-A: 787-793
- Glenohumeral dysplasia following neonatal brachial plexus palsy: presentation and predictive features during infancy.J Hand Surg Am. 2015; 40: 2345-2351.e1
- Deformities of the shoulder in infants younger than 12 months with an obstetric lesion of the brachial plexus.J Bone Joint Surg Br. 2001; 83: 551-555
- The role of subscapularis muscle denervation in the pathogenesis of shoulder internal rotation contracture after neonatal brachial plexus palsy: a study in a rat model.J Orthop Res. 2014; 32: 1675-1679
- Computational sensitivity analysis to identify muscles that can mechanically contribute to shoulder deformity following brachial plexus birth palsy.J Hand Surg Am. 2014; 39: 303-311
- Structural changes in muscle and glenohumeral joint deformity in neonatal brachial plexus palsy.J Bone Joint Surg Am. 2010; 92: 935-942
- Arthroscopically assisted Sever-L'Episcopo procedure improves clinical and radiographic outcomes in neonatal brachial plexus palsy patients.J Pediatr Orthop. 2011; 31: 341-351
- Arthroscopic release and latissimus dorsi transfer for shoulder internal rotation contractures and glenohumeral deformity secondary to brachial plexus birth palsy.J Bone Joint Surg Am. 2006; 88: 564-574
- Update on management of pediatric brachial plexus palsy.J Pediatr Orthop B. 2005; 14: 233-244
- The effect of derotational humeral osteotomy on global shoulder function in brachial plexus birth palsy.J Bone Joint Surg Am. 2006; 88: 1035-1042
- Combined glenoid anteversion osteotomy and tendon transfers for brachial plexus birth palsy: early outcomes.J Bone Joint Surg Am. 2012; 94: 2145-2152
- Pediatric brachial plexus palsy.in: Wolfe S.W. Pederson W.C. Hotchkiss R.N. Kozin S.H. Cohen M.S. Green's Operative Hand Surgery. Elsevier, Philadelphia2017: 1391-1424
- Arthroscopic treatment of internal rotation contracture and glenohumeral dysplasia in children with brachial plexus birth palsy.J Shoulder Elbow Surg. 2010; 19: 102-110
- Magnetic resonance imaging and clinical findings before and after tendon transfers about the shoulder in children with residual brachial plexus birth palsy.J Shoulder Elbow Surg. 2006; 15: 554-561
- Arthroscopic treatment of posterior glenohumeral joint subluxation resulting from brachial plexus birth palsy.J Shoulder Elbow Surg. 2007; 16: 6-13
- Glenoid deformity secondary to brachial plexus birth palsy.J Bone Joint Surg Am. 1998; 80: 659-667
- Glenohumeral deformity secondary to brachial plexus birth palsy.J Bone Joint Surg Am. 1998; 80: 668-677
- Correlation between external rotation of the glenohumeral joint and deformity after brachial plexus birth palsy.J Pediatr Orthop. 2004; 24: 189-193
- Effect of tendon transfers and extra-articular soft-tissue balancing on glenohumeral development in brachial plexus birth palsy.J Bone Joint Surg Am. 2005; 87: 320-325
- MR imaging of the normal developmental anatomy of the elbow.Magn Reson Imaging Clin N Am. 1997; 5: 501-513
- Glenohumeral abduction contracture in children with unresolved neonatal brachial plexus palsy.J Bone Joint Surg Am. 2015; 97: 112-118
- Scapular deformity in obstetric brachial plexus palsy: a new finding.Surg Radiol Anat. 2007; 29: 133-140
- Variability of measurement of glenoid version on computed tomography scan.J Shoulder Elbow Surg. 1999; 8: 595-598
- Two-dimensional glenoid version measurements vary with coronal and sagittal scapular rotation.J Bone Joint Surg Am. 2010; 92: 692-699
- Comparison of standard two-dimensional and three-dimensional corrected glenoid version measurements.J Shoulder Elbow Surg. 2011; 20: 577-583
- Tendon transfer around the shoulder in obstetric brachial plexus paralysis: clinical and computed tomographic study.J Pediatr Orthop. 2006; 26: 641-646
- The early effects of tendon transfers and open capsulorrhaphy on glenohumeral deformity in brachial plexus birth palsy. Surgical technique.J Bone Joint Surg Am. 2009; 91: 213-222
- Three-dimensional magnetic resonance imaging of glenohumeral dysplasia in neonatal brachial plexus palsy.J Bone Joint Surg Am. 2016; 98: 142-151
- The intrarater and interrater reliability of glenoid version and glenohumeral subluxation measurements in neonatal brachial plexus palsy.J Pediatr Orthop. 2012; 32: 378-384
- The measurement of observer agreement for categorical data.Biometrics. 1977; 33: 159-174
- Intraclass correlations: uses in assessing rater reliability.Psychol Bull. 1979; 86: 420-428
- Use of three-dimensional computed tomography for the analysis of the glenoid anatomy.J Shoulder Elbow Surg. 2005; 14: 85-90
- Glenohumeral deformity in children with internal rotation contractures secondary to brachial plexus birth palsy: intraoperative arthrographic classification.Radiology. 2004; 231: 791-795
- Comparison of arthroscopic findings with magnetic resonance imaging and arthrography in children with glenohumeral deformities secondary to brachial plexus birth palsy.J Bone Joint Surg Am. 2003; 85-A: 890-898
- Secondary deformities of the shoulder in infants with an obstetrical brachial plexus lesions considered for neurosurgical treatment.Neurosurg Focus. 2004; 16: E9
- The use of computerized tomography in the measurement of glenoid version.J Bone Joint Surg Am. 1992; 74: 1032-1037
- Shoulder problems in children with brachial plexus birth palsy: evaluation and management.J Am Acad Orthop Surg. 2009; 17: 242-254
- Glenohumeral osteometry by computed tomography in normal and unstable shoulders.Clin Orthop Relat Res. 1986; 208: 151-156
- Measuring secondary deformities of the shoulder in children with obstetric brachial plexus lesion: reliability of three methods.J Pediatr Orthop B. 2003; 12: 211-214
- Current concepts in the management of brachial plexus birth palsy.J Hand Surg Am. 2010; 35: 322-331
- Three dimensionality of gleno-humeral deformities in obstetrical brachial plexus palsy.J Orthop Res. 2016; 34 (675–62)
- Reliability of three classification systems measuring active motion in brachial plexus birth palsy.J Bone Joint Surg Am. 2003; 85-A: 1733-1738
Published online: August 16, 2017
Accepted: July 3, 2017
Received: July 28, 2016
No benefits in any form have been received or will be received related directly or indirectly to the subject of this article.
© 2017 by the American Society for Surgery of the Hand. All rights reserved.