Outcome of secondary shoulder surgery in children with neonatal brachial plexus palsy with and without nerve surgery treatment history: A long-term follow-up study
Menno van der Holst, C.W.P.Gerco van der Wal, Ron Wolterbeek, Willem Pondaag, Thea P. M. Vliet Vlieland, Rob G.H.H. Nelissen
Department of Orthopaedics, Rehabilitation and Physical Therapy, Leiden University Medical Center, NL-2300 RC Leiden, The Netherlands. E-mail: email@example.com
Objective: Irrespective of treatment history, shoulder dysfunction may occur in children with neonatal brachial plexus palsy. Following internal contracture release and/or muscle tendon transfer (ICR/MTT) shoulder function gain is possible. This study describes the outcomes of ICR/MTT for children with neonatal brachial plexus palsy, with or without prior nerve surgery (a group with prior nerve surgery and a group without prior nerve surgery).
Patients and methods: The study included children who underwent an ICR/MTT with a minimum follow-up of 6 months. Active/passive range of motion (aROM/pROM)/Mallet scores were recorded (pre-operatively, 6 months, and 1, 3, 5 and 10 years post-surgery). Changes over time within groups were analysed using a linear mixed model.
Results: A total of 115 children (60 boys) were included, 82 with nerve surgery history, mean age 4.7 years (standard deviation (SD) 3.3 years), mean follow-up 6 years (SD 3.2 years). Pre-operatively active external rotation, abduction and forward-flexion were worse in the group with prior nerve surgery. aROM, pROM and Mallet scores, improved at all time-points in both groups. The course and magnitude of these improvements were largely similar in both groups. In the long-term, the effects of ICR/MTT decrease, but remain significant.
Conclusion: In children with neonatal brachial plexus palsy shoulder function improved after ICR/MTT, irrespective of treatment history. Pre-operative shoulder function was worse in the group with prior nerve surgery, resulting in less function in this group after ICR/MTT. Reporting on outcome after secondary shoulder surgery should be stratified into children with and without prior nerve surgery, in order to prevent over- or underestimation of results.
Level of evidence: This study concerned a retrospective treatment case series study. Level of evidence: IV.
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