2016, Number 1
<< Back Next >>
Revista Cubana de Ortopedia y Traumatología 2016; 30 (1)
Usefulness of ultrasound in assessing shoulder in obstetric brachial plexus paralysis
Moreno LÁ, Vergara-Amador E, Cárdenas VR
Language: Spanish
References: 20
Page: 53-64
PDF size: 398.57 Kb.
ABSTRACT
Introduction: Shoulder adduction is frequently in obstetric brachial plexus paralysis,
as well as internal rotation and external rotation loss with muscle imbalance between
internal and external rotators. This leads to alteration of the glenohumeral joint. The
aim of this report is to show the usefulness of ultrasonography in the diagnosis and
monitoring of alterations in this joint.
Method: A number of cases was studied for children with obstetric brachial plexus
paralysis, all with internal rotation attitude and adduction of the shoulder. Shoulder
ultrasound is performed to determine changes in the glenohumeral joint. The position
of the humeral head ossification with respect to the shoulder line is determined; the
alpha angle was measured and the degree of subluxation of the humeral head was
checked.
Results: Ten patients were evaluated with an average age of 15 months. Posterior
subluxation was seen in five cases with posterior core relative to the shoulder line and
alpha angle greater than 30°. In four cases with normal angle, asymmetry of at least
10 degrees from the contralateral shoulder was seen.
Conclusions: Shoulder ultrasound is the imaging modality of choice for initial
assessment and monitoring of shoulder in obstetric brachial plexus paralysis. It is an
economic resource that can diagnose the presence and degree of posterior
subluxation and does not require sedation or use of ionizing radiation.
REFERENCES
Gilbert A. Paralysie obstetricale du plexus brachial. In: Alnot JY, Narakas A, eds. Les Paralysis du Plexlus Brachial. 2nd ed. Monographie de la Societe Francais de Chirurgie de la Main. Paris, France: Expansion Scientifique Français; 1995. p. 270.
Clarke H, Curtis C. Examination and prognosis. In: Gilbert A, ed. Brachial plexus injuries. London, United Kingdom: Martin-Dunitz; 2001. p. 159-72.
Vergara-Amador E. Parálisis obstétrica del plexo braquial. Revisión del estado actual de la enfermedad. Rev Fac Med. 2014;62(2):255-63.
Pondaag W, Lee R, Shenaq S, Parke JT, Solis IS, Kowalik L. Natural history of obstetric brachial plexus palsy: a systematic review. Dev Med Child Neurol. 2004;46:138-44.
Hale HB, Bae DS, Waters PM. Current concepts in the management of brachial plexus birth palsy. J Hand Surg. 2010;35A:322-31.
Hunter JD, Franklin K, Hughes PM. The ultrasound diagnosis of posterior shoulder dislocation associated with Erb's palsy. Pediatr radiol. 1998;28(7):510-1.
Grissom LE, Harcke HT. Infant shoulder sonography: technique, anatomy, and pathology. Pediatr radiol. 2001;31(12):863-8.
Saifuddin A, Heffernan G, Birch R. Ultrasound diagnosis of shoulder congruity in chronic obstetric brachial plexus palsy. J Bone Joint Surg Br. 2002;84(1):100-3.
Pöyhiä TH, Lamminen AE, Peltonen JI, Kirjavainen MO, Willamo PJ, Nietosvaara Y. Brachial plexus birth injury: US screening for glenohumeral joint instability. Radiology.2010;254(1):253-60.
Sanchez TR, Chang J, Bauer A, Joyce NC, Patel CV. Dynamic Sonographic Evaluation of Posterior shoulder Dislocation Secondary to Brachial Plexus Birth Palsy Injury. J Ultrasound Med. 2013;32(9):1531-4.
Dunkerton MC. Posterior dislocation of the shoulder associated with obstetric brachial plexus palsy. J Bone Joint Surg Br. 1989;71(5):764-6.
Van der Sluijs JA, Van der Meij M, Verbeke J, Manoliu RA, Wuisman PI. Measuring secondary deformities of the shoulder in children with obstetric brachial plexus lesion: Reliability of three methods. J Pediatr Orthop B. 2003;12(3):211-4.
Pearl ML, Edgerton BW. Glenoid deformity secondary to brachial plexus birth palsy. J Bone Joint Surg Am. 1998;80(5):659-67.
Martinoli C, Bianchi S, Santacroce E, Pugliese F, Graif M, Derchi LE. Brachial plexus sonography: a technique for assessing the root level. AJR Am J Roentgenol. 2002;179(3):699-702.
Birch R. Medial rotation contraction and posterior dislocation of the shoulder. In: Gilbert A, ed. Brachial plexus injuries. London, United Kingdom: Martin-Dunitz, 2001:249-259.
Al-Qattan M M. Classification of secondary shoulder deformities in obstetric brachial plexus palsy. J Hand Surg Br. 2003;28(5):483-6.
Soldado F, Fontecha CG, Marotta M, Benito D, Casaccia, M, Mascarenhas VV, Zlotolow D, Kozin SH. The role of muscle imbalance in the pathogenesis of shoulder contracture after neonatal brachial plexus palsy: a study in a rat model. J Shoulder Elbow Surg. 2014;23(7):1003-9.
Saifuddin A, Heffernan G, Birch R. Ultrasound diagnosis of shoulder congruity in chronic obstetric brachial plexus palsy. J Bone Joint Surg Br. 2002;84(1):100-3.
Vathana T, Rust S, Mills J, Wilkes D, Browne R, Carter PR, et al. Intraobserver and interobserver reliability of two ultrasound measures of humeral head position in infants with neonatal brachial plexus palsy. J Bone Joint Surg. 2007; 89(8):1710-5.
Kozin SH, Zlotolow DA. Advanced imaging and arthroscopic management of shoulder contracture after birth palsy. Hand Clin. 2012;28(4):541-50.