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

Abstract

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.

• Authors: Giuseppe Porcellini, Marco Montemagno, Chiara Manzini, Gabriele Fiumana, Andrea Giorgini, Gianmario Micheloni, Luigi Tarallo
• Journal: Journal of orthopaedics and traumatology : official journal of the Italian Society of Orthopaedics and Traumatology (J Orthop Traumatol) Vol. 24 Issue 1 Pg. 59 (Nov 10 2023) ISSN: 1590-9999 [Electronic] Italy
• PMID: 37947898 (Publication Type: Journal Article)
• Copyright: © 2023. The Author(s).

Topics

• Humans
• Middle Aged
• Shoulder (surgery)
• Arthroplasty, Replacement, Shoulder
• Prospective Studies
• Quality of Life
• Brachial Plexus Neuropathies (surgery, complications)
• Brachial Plexus (surgery, injuries)
• Shoulder Joint (surgery)
• Upper Extremity
• Paralysis (complications, surgery)
• Pain
• Range of Motion, Articular (physiology)
• Treatment Outcome