- 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.
