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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.