Purpose
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.
Methods
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.
Results
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.
Conclusions
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
Diagnostic III.
Key words
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Article info
Publication history
Published online: August 16, 2017
Accepted:
July 3,
2017
Received:
July 28,
2016
Footnotes
No benefits in any form have been received or will be received related directly or indirectly to the subject of this article.
Identification
Copyright
© 2017 by the American Society for Surgery of the Hand. All rights reserved.
