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Shoulder Problems in Children With Brachial Plexus Birth Palsy: Evaluation and Management

Dr. Pearl is Shoulder and Elbow Surgeon, Kaiser Permanente, Los Angeles Medical Group, Los Angeles, CA, and Assistant Clinical Professor, Department of Orthopaedic Surgery, University of Southern California, Los Angeles.

Supported in part by research grants from Kaiser Permanente Southern California and American Shoulder and Elbow Surgeons. Dr. Pearl or a member of his immediate family has received royalties from Zimmer.

Michael L. Pearl, MD

Shoulder Problems in Children With Brachial Plexus Birth Palsy

Reprint requests: Dr. Pearl, Kaiser Permanente, Los Angeles Medical Center, 4760 Sunset Boulevard, Los Angeles, CA 90027.

Traction injury to the brachial plexus sustained during the birth process that results in impaired neuromuscular function of the upper extremity continues to occur despite advances in modern obstetric care. The most common pattern of injury usually results in motor weakness of shoulder external rotation, leading to internal rotation contractures and subsequent deformity of the skeletally immature glenohumeral joint. Understanding of these deformities and effective surgical intervention have advanced greatly over the past decade. Restoration of balance between internal and external rotation forces around the shoulder has great potential for remodeling of the glenohumeral joint in the young child. Arthroscopic-directed release of the contracture, with select use of latissimus dorsi transfer to provide external rotation power, has proved to be effective for many children with these contractures.