Purpose
Shoulder internal rotation contractures (IRC) are common sequela of brachial plexus
birth injuries (BPBI). Botulinum toxin A (BTX-A) injection into targeted muscles has
been described to facilitate functional improvement at the shoulder joint and prevent
glenohumeral dysplasia. The purpose of this study was to assess the outcomes of BTX-A
injections on shoulder IRC in children with BPBI.
Methods
We conducted a retrospective analysis of 47 children with shoulder IRC due to BPBI,
who were treated with BTX-A. Shoulder passive external rotation in adduction and Active
Movement Scale external rotation scores were recorded before and after BTX-A injection.
We also recorded the number of children who underwent secondary surgical balancing
procedures to improve shoulder motion after BTX-A injection.
Results
Mean age at the time of injection was 12 months (range, 5–23 months). Subjects demonstrated
a significant increase in passive external rotation of 46° (range, 10° to 90) at 4
months; an average improvement of 18° (range, –30° to 80°) persisted at 11 months
after injection. A total of 28 patients (60%) underwent subsequent external rotation
tendon transfer. At 5-year follow-up, 7 patients (15%) had adequate functional shoulder
range of motion and did not undergo external rotation tendon transfer.
Conclusions
Botulinum toxin A injections result in improvement in IRC due to BPBI, which is sustained
beyond the expected half-life of 3 months. As many as 15% of patients who have this
treatment avoid external rotation tendon transfer.
Type of study/level of evidence
Diagnostic IV.
Key words
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Article info
Publication history
Published online: August 02, 2020
Accepted:
June 16,
2020
Received:
August 6,
2019
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
© 2020 by the American Society for Surgery of the Hand. All rights reserved.
