Radiographic and Clinical Outcomes of the Shoulder in Long-Term Follow-Up of Brachial Plexus Birth Injury

Published:October 23, 2020DOI:https://doi.org/10.1016/j.jhsa.2020.09.001

      Purpose

      The purpose of this study was to examine radiographic and functional outcomes of the shoulder in brachial plexus birth injury (BPBI) patients at long-term follow-up.

      Methods

      Medical records were reviewed at the Shriners Hospital in St. Louis to identify patients older than 18 years with a diagnosis of BPBI. Twenty-five patients were included in this study. Evaluations included radiographic examination, clinical examination, and outcome measures including the Mallet classification, visual analog scale (VAS) for shoulder pain, American Shoulder and Elbow Shoulder score (ASES), quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH), Simple Shoulder Test (SST), and Patient-Reported Outcomes Measurement Information System (PROMIS) domain measures.

      Results

      The mean age of the patients included was 44 years. Average follow-up was 37 years. No patient had primary nerve reconstruction surgery. Thirteen patients had a history of shoulder surgery at an average age of 6 years. There was a wide spectrum of deformity seen radiographically. Fifty-five percent of patients had evidence of glenoid retroversion, posterior humeral translation, or a biconcave glenoid. An additional 20% of patients had complete posterior dislocation of the humeral head. Despite the degenerative changes seen on radiographs, the mean VAS for pain was low, at 2. The mean ASES shoulder score was 54. The mean QuickDASH score was 30. Mean PROMIS Physical Function, Pain Interference, Depression, and Anxiety scores were near the means for the general population, with similar outcomes in patients treated with shoulder surgery compared with those treated without surgery.

      Conclusions

      Adult BPBI patients experience minimal shoulder pain despite deformity and degenerative changes on shoulder radiographs. Whereas there are significant deficits in range of motion and function, PROMIS scores in adult BPBI patients are normal.

      Type of study/level of evidence

      Therapeutic IV.

      Key words

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      References

        • Nikolaou S.
        • Peterson E.
        • Kim A.
        • Wylie C.
        • Cornwall R.
        Impaired growth of denervated muscle contributes to contracture formation following neonatal brachial plexus injury.
        J Bone Joint Surg Am. 2011; 93: 461-470
        • Soldado F.
        • Fontecha C.G.
        • Marotta M.
        • et al.
        The role of muscle imbalance in the pathogenesis of shoulder contracture after neonatal brachial plexus palsy: a study in a rat model.
        J Shoulder Elbow Surg. 2014; 23: 1003-1009
        • Hogendoorn S.
        • van Overvest K.L.
        • Watt I.
        • Duijsens A.H.
        • Nelissen R.G.H.H.
        Structural changes in muscle and glenohumeral joint deformity in neonatal brachial plexus palsy.
        J Bone Joint Surg Am. 2010; 92: 935-942
        • Waters P.M.
        • Smith G.R.
        • Jaramillo D.
        Glenohumeral deformity secondary to brachial plexus birth palsy.
        J Bone Joint Surg Am. 1998; 80: 668-677
        • Pearl M.L.
        • Edgerton B.W.
        • Kazimiroff P.A.
        • Burchette R.J.
        • Wong K.
        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
        • Waters B.P.
        • Bae D.S.
        The early effects of tendon transfers and open capsulorrhaphy on glenohumeral deformity in brachial plexus birth injury.
        J Bone Joint Surg Am. 2008; 90: 2171-2179
        • Pearl M.L.
        Shoulder problems in children with brachial plexus birth palsy: evaluation and management.
        J Am Acad Orthop Surg. 2009; 17: 242-254
        • Hui J.H.P.
        • Torode I.P.
        Changing glenoid version after open reduction of shoulders in children with obstetric brachial plexus palsy.
        J Pediatr Orthop. 2003; 23: 109-113
        • Chang K.W.C.
        • Justice D.
        • Chung K.C.
        • Yang L.J.S.
        A systematic review of evaluation methods for neonatal brachial plexus palsy.
        J Neurosurg Pediatr. 2013; 12: 395-405
        • Carlioz H.
        • Brahimi L.
        Place of internal disinsertion of the subscapularis muscle in the treatment of obstetric paralysis of the upper limb in children.
        Ann Chir Infant. 1971; 12: 159-167
        • Kirkos J.M.
        • Kyrkos M.J.
        • Kapetanos G.A.
        • Haritidis J.H.
        Brachial plexus palsy secondary to birth injuries.
        J Bone Joint Surg Br. 2005; 87: 231-235
        • Waters P.M.
        • Bae D.S.
        Effect of tendon transfers and exrea-articuar soft-tissue balancing on glenohumeral development in brachial plexus birth palsy.
        J Bone Joint Surg Am. 2005; 87: 320-325
        • Hale H.B.
        • Bae D.S.
        • Waters P.M.
        Current concepts in the management of brachial plexus birth palsy.
        J Hand Surg Am. 2010; 35: 322-331
        • Ing C.
        • DiMaggio C.
        • Whitehouse A.
        • et al.
        Long-term differences in language and cognitive function after childhood exposure to anesthesia.
        Pediatrics. 2012; 13: e476-e485
        • Samilson R.L.
        • Prieto V.
        Dislocation arthropathy of the shoulder.
        J Bone Joint Surg Am. 1983; 65: 456-460
        • Mallet J.
        Obstetrical paralysis of the brachial plexus. 3. Conclusions [in French].
        Rev Chir Orthop Reparatrice Appar Mot. 1972; 58 (210–204)
        • Greenhill D.A.
        • Lukavsky R.
        • Tomlinson-Hansen S.
        • Kozin S.H.
        • Zlotolow D.A.
        Relationships between 3 classification systems in brachial plexus birth palsy.
        J Pediatr Orthop. 2017; 37: 374-380
        • Kocher M.S.
        • Horan M.P.
        • Briggs K.K.
        • Richardson T.R.
        • O’Holleran J.
        • Hawkins R.J.
        Reliability, validity, and responsiveness of the American Shoulder and Elbow Surgeons subjective shoulder scale in patients with instability, rotator cuff disease, and glenohumeral arthritis.
        J Bone Joint Surg Am. 2005; 87: 2006-2011
        • Godfrey J.
        • Hamman R.
        • Lowenstein S.
        • Briggs K.
        • Kocher M.
        Reliability, validity, and responsiveness of the simple shoulder test: psychometric properties by age and injury type.
        J Shoulder Elbow Surg. 2007; 16: 260-267
        • Reeve B.B.
        • Hays R.D.
        • Bjorner J.B.
        • et al.
        Psychometric evaluation and calibration of health-related quality of life item banks: plans for the Patient-Reported Outsomes Measurement Information System (PROMIS).
        Med Care. 2007; 45: 22-31
        • Pearl M.L.
        • Edgerton B.W.
        Glenoid deformity secondary to brachial plexus birth palsy.
        J Bone Joint Surg Am. 1998; 80: 659-667
        • Kirkos M.J.
        • Kyrkos M.J.
        • Kapetanos G.A.
        • Haritidis J.H.
        Brachial plexus palsy secondary to birth injuries.
        . 2005; 87: 231-235
        • Anand P.
        • Birch R.
        Restoration of sensory function and lack of long-term chronic pain syndromes after brachial plexus injury in human neonates.
        Brain. 2002; 125: 113-122
        • Werthel J.D.
        • Schoch B.
        • Frankle M.
        • Cofield R.
        • Elhassan B.T.
        Shoulder arthroplasty for sequelae of obstetrical brachial plexus injury.
        J Hand Surg Am. 2018; 43: 871.e1-871.e7
        • Wilson T.J.
        • Chang K.W.C.
        • Yang L.J.S.
        Depression and anxiety in traumatic brachial plexus injury patients are associated with reduced motor outcome after surgical intervention for restoration of elbow flexion.
        Neurosurgery. 2016; 78: 844-849
        • Squitieri L.
        • Larson B.P.
        • Chang K.W.
        • Yang L.J.
        • Chung K.C.
        Understanding quality of life and patient expectations among adolescents with neonatal brachial plexus palsy: a qualitative and quantitative pilot study.
        J Hand Surg Am. 2013; 38: 2387-2397.e2
        • Butler L.
        • Mills J.
        • Richard H.M.
        • Riddle R.
        • Ezaki M.
        • Oishi S.
        Long-term follow-up of neonatal brachial plexopathy: psychological and physical function in adolescents and young adults.
        J Pediatr Orthop. 2017; 37: e364-e368

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