[A long-term follow up of the shoulder in obstetrical brachial palsy].

OBJECTIVES

To study shoulder impairment and disability caused by obstetrical brachial plexus palsy, their evolution under physical and surgical treatments, and the place of complementary explorations in persistent sequels.

METHODS

From 1991 to 2000, 129 patients (66 M, 63 F) were included in a retrospective study. Impairment was assessed by muscle recovery (deltoid, biceps, external rotators) and shoulder passive motion. Disability was assessed by Mallet functional test.

RESULTS

Full spontaneous recovery was noted in 20% of patients before the age of 3 months. Repair of the nerve lesion was undertaken in four children between the 18th and 24th months. Full recovery of deltoid and biceps was noted in three-fourth of whole cases before the 12th month, and of the external rotation in only 45% at this same age. Seventy-seven percent of patients showed stage >or= III of Mallet test (VI: 20%, IV: 32%; III: 25%) at a middle age of 3.5 years. A long-term follow-up showed an external rotation limited less than 20 degrees in 15 children. Investigation by RMN or Arthroscanner was realized for five patients, this reveals a deformation with subluxation of the humeral head in two cases. Ten children were operated (liberation of sub-scapula in nine cases associated to a tendinous transfer six times; humeral osteotomie in one case). This surgery has allowed the improvement of the functional state in all cases.

CONCLUSION

After-effects in shoulder are frequent especially the limitation of external rotation, which can lead to a deformation, and subluxation of the humeral head. The authors insist on the importance to push investigations in case of limitation of the passive external rotation to improve the therapeutic choice.