Shoulder in Brachial Plexus Palsy


- See:
     - Obstetrical Paralysis
     - Erb's Palsy

- Discussion:
       - following Erb's palsy, shoulder may end up with medial rotation-adduction contracture w/ or w/o shoulder subluxation;
             - due to overpull of the subscapularis, pectoralis major and minor, latissimus, and teres major which function normally;
             - primary muscles causing the contracture are the subscapularis
      - goals of treatment:
             - release myostatic contractures (internal rotators and shoulder adductors);
             - increase ability to actively externally rotate and abduct the shoulder;

- Treatment:
    - L'Episcopo:
         - transfer of teres major to a lateral position, causing it to be a lateral rotator of the shoulder;
         - modified L'Episcopo involves additional transfer of latissimus;
    - Zancolli:
         - transfer of only latissimus, passing it around the humerus under the deltoid thru the quadrilateral space;
    - Proximal Humeral Osteotomy:
         - will bring the distal segment out of severe internal rotation;
         - its important not to over correct the shoulder in this procedure;
    - Shoulder Arthrodesis



Shoulder arthrodesis using a pelvic-reconstruction plate. A report of eleven cases.

Modification of the L'Episcopo procedure for brachial plexus birth palsies.



Original Text by Clifford R. Wheeless, III, MD.

Last updated by Data Trace Staff on Thursday, September 13, 2012 1:02 pm