Reverse shoulder arthroplasty in obstetric brachial plexus injury: our experience with shoulder motion analysis

• Published in: Journal of orthopaedics and traumatology Vol. 24; no. 1; p. 59
• Main Authors: Porcellini, Giuseppe, Montemagno, Marco, Manzini, Chiara, Fiumana, Gabriele, Giorgini, Andrea, Micheloni, Gianmario, Tarallo, Luigi
• Format: Journal Article
• Language: English
• Published: Cham Springer International Publishing 10-11-2023; Springer Nature B.V; SpringerOpen
• Subjects: Arm; Arthroplasty; Brachial plexus; Conservative Orthopedics; Demographics; Erb palsy; Injuries; Injury analysis; Joint surgery; Joints (anatomy); Medicine; Medicine & Public Health; Motion detection; Movement; Muscles; Obstetric brachial plexus palsy; Obstetrics; Original; Original Article; Orthopedics; Pain; Paralysis; Quality of life; Reverse shoulder arthroplasty; Rheumatology; Rotation; Shoulder; Shoulder motion analysis; Sports Medicine; Surgical Orthopedics; Traumatic Surgery; Shoulder motion analysis; Obstetric brachial plexus palsy; Erb palsy; Reverse shoulder arthroplasty
• ISSN: 1590-9999; 1590-9921; 1590-9999
• DOI: 10.1186/s10195-023-00736-0

Background
Obstetric brachial plexus injury (OBPI) is a weakening or paralysis of the upper arm caused by brachial plexus injury followed by a muscle paralysis with severe repercussions on the movement of the shoulder joint following a progressive glenohumeral joint deformity.
This case series analyzes the clinical and radiological outcomes of reverse total shoulder arthroplasty (RSA) in OBPI patients with a follow-up of 2 years.
Materials and methods
OBPI patients with secondary end-stage glenohumeral arthritis were enrolled in the study and they were treated with RSA. Patient demographics and clinical outcomes [Range of Motion (ROM), Visual Analog Scale (VAS), Oxford Shoulder Score (OSS)] were evaluated. A novel Shoulder motion analysis was carried out to investigate specific movement patterns of scapulothoracic movements in these patients. This study is a prospective cohort study.
Results
Four Patients (M:
F
 = 1:3) were enrolled in the study, the mean age was 49.3 years (+ 2.75), the mean OSS (Oxford Shoulder Score) decreased from 48.8 (± 2.5) preoperatively to 18.30 (± 2.78), the mean VAS (Visual Analog Scale) decreased from 7.25 (± 0.5) to 1.7 (± 0.3) in the follow up (∆% relative pain reduction:− 76.5%), Shoulder ROM obtained an improvement (
p
 < 0.05) except for abduction and external rotation. The average follow-up time was 26.3 months (+− 4.5). Shoulder motion analysis showed a complete loss of the scapular tilting above 90 degrees of flexion compared to the typical one of standard RSA with a pattern shifted towards scapular retraction (engaging trapezius and rhomboid muscles) to compensate the loss of the posterior tilting.
Conclusions
RSA in OBPI patients demonstrated a significant improvement of pain symptoms and a moderate improvement in daily activities, anyway with a more appreciable quality of life over time even if the marked hypotrophy especially of the posterior shoulder muscles showed some limits in maintaining suspension of the upper limb and a minor external rotation, with an internal rotation attitude during the movements.
Level of evidence
: Level IV, Case series.