Document Detail

Subscapularis slide correction of the shoulder internal rotation contracture after brachial plexus birth injury: technique and outcomes.
MedLine Citation:
PMID:  23423238     Owner:  NLM     Status:  In-Data-Review    
Internal rotation contracture is the most common shoulder deformity in patients with brachial plexus birth injury. The purpose of this investigation is to describe the indications, technique, and results of the subscapularis slide procedure. The technique involves the release of the subscapularis muscle origin off the scapula, with preservation of anterior shoulder structures. A standard postoperative protocol is used in all patients and includes a modified shoulder spica with the shoulder held in 60 degrees of external rotation and 30 degrees of abduction, aggressive occupational and physical therapy, and subsequent shoulder manipulation under anesthesia with botulinum toxin injections as needed. Seventy-one patients at 2 institutions treated with subscapularis slide between 1997 and 2010, with minimum follow-up of 39.2 months, were identified. Patients were divided into 5 groups based on the index procedure performed: subscapularis slide alone (group 1); subscapularis slide with a simultaneous microsurgical reconstruction (group 2); primary microsurgical brachial plexus reconstruction followed later by a subscapularis slide (group 3); primary microsurgical brachial plexus reconstruction followed later by a subscapularis slide combined with tendon transfers for shoulder external rotation (group 4); and subscapularis slide with simultaneous tendon transfers, with no prior brachial plexus surgery (group 5). Full passive external rotation equivalent to the contralateral side was achieved in the operating room in all cases. No cases resulted in anterior instability or internal rotation deficit. Internal rotation contracture of the shoulder after brachial plexus birth injury can be effectively managed with the technique of subscapularis slide.
Igor Immerman; Herbert Valencia; Patricia Ditaranto; Edward M Delsole; Sergio Glait; Andrew E Price; John A I Grossman
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Techniques in hand & upper extremity surgery     Volume:  17     ISSN:  1531-6572     ISO Abbreviation:  Tech Hand Up Extrem Surg     Publication Date:  2013 Mar 
Date Detail:
Created Date:  2013-02-20     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9704676     Medline TA:  Tech Hand Up Extrem Surg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  52-6     Citation Subset:  IM    
*Department of Orthopedic Surgery, Hospital for Joint Diseases, New York, NY †Brachial Plexus Program, Miami Children's Hospital, Miami, FL.
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