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 ser...
| Main Authors: | , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
SpringerOpen
2023-11-01
|
| Series: | Journal of Orthopaedics and Traumatology |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s10195-023-00736-0 |
| _version_ | 1827764166654427136 |
|---|---|
| author | Giuseppe Porcellini Marco Montemagno Chiara Manzini Gabriele Fiumana Andrea Giorgini Gianmario Micheloni Luigi Tarallo |
| author_facet | Giuseppe Porcellini Marco Montemagno Chiara Manzini Gabriele Fiumana Andrea Giorgini Gianmario Micheloni Luigi Tarallo |
| author_sort | Giuseppe Porcellini |
| collection | DOAJ |
| description | 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. |
| first_indexed | 2024-03-11T11:01:55Z |
| format | Article |
| id | doaj.art-20a5d999d0e04c65ae2480c6f1f61219 |
| institution | Directory Open Access Journal |
| issn | 1590-9999 |
| language | English |
| last_indexed | 2024-03-11T11:01:55Z |
| publishDate | 2023-11-01 |
| publisher | SpringerOpen |
| record_format | Article |
| series | Journal of Orthopaedics and Traumatology |
| spelling | doaj.art-20a5d999d0e04c65ae2480c6f1f612192023-11-12T12:26:35ZengSpringerOpenJournal of Orthopaedics and Traumatology1590-99992023-11-012411810.1186/s10195-023-00736-0Reverse shoulder arthroplasty in obstetric brachial plexus injury: our experience with shoulder motion analysisGiuseppe Porcellini0Marco Montemagno1Chiara Manzini2Gabriele Fiumana3Andrea Giorgini4Gianmario Micheloni5Luigi Tarallo6Orthopedic and Traumatology Department, University of Modena and Reggio EmiliaDepartment of General Surgery and Medical Surgical Specialties, Section of Orthopaedics and Traumatology, University Hospital Policlinico-San Marco, University of CataniaOrthopedic and Traumatology Department, University of Modena and Reggio EmiliaShoulder Team S.R.L.Orthopedic and Traumatology Department, University of Modena and Reggio EmiliaOrthopedic and Traumatology Department, University of Modena and Reggio EmiliaOrthopedic and Traumatology Department, University of Modena and Reggio EmiliaAbstract 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.https://doi.org/10.1186/s10195-023-00736-0Obstetric brachial plexus palsyErb palsyReverse shoulder arthroplastyShoulder motion analysis |
| spellingShingle | Giuseppe Porcellini Marco Montemagno Chiara Manzini Gabriele Fiumana Andrea Giorgini Gianmario Micheloni Luigi Tarallo Reverse shoulder arthroplasty in obstetric brachial plexus injury: our experience with shoulder motion analysis Journal of Orthopaedics and Traumatology Obstetric brachial plexus palsy Erb palsy Reverse shoulder arthroplasty Shoulder motion analysis |
| title | Reverse shoulder arthroplasty in obstetric brachial plexus injury: our experience with shoulder motion analysis |
| title_full | Reverse shoulder arthroplasty in obstetric brachial plexus injury: our experience with shoulder motion analysis |
| title_fullStr | Reverse shoulder arthroplasty in obstetric brachial plexus injury: our experience with shoulder motion analysis |
| title_full_unstemmed | Reverse shoulder arthroplasty in obstetric brachial plexus injury: our experience with shoulder motion analysis |
| title_short | Reverse shoulder arthroplasty in obstetric brachial plexus injury: our experience with shoulder motion analysis |
| title_sort | reverse shoulder arthroplasty in obstetric brachial plexus injury our experience with shoulder motion analysis |
| topic | Obstetric brachial plexus palsy Erb palsy Reverse shoulder arthroplasty Shoulder motion analysis |
| url | https://doi.org/10.1186/s10195-023-00736-0 |
| work_keys_str_mv | AT giuseppeporcellini reverseshoulderarthroplastyinobstetricbrachialplexusinjuryourexperiencewithshouldermotionanalysis AT marcomontemagno reverseshoulderarthroplastyinobstetricbrachialplexusinjuryourexperiencewithshouldermotionanalysis AT chiaramanzini reverseshoulderarthroplastyinobstetricbrachialplexusinjuryourexperiencewithshouldermotionanalysis AT gabrielefiumana reverseshoulderarthroplastyinobstetricbrachialplexusinjuryourexperiencewithshouldermotionanalysis AT andreagiorgini reverseshoulderarthroplastyinobstetricbrachialplexusinjuryourexperiencewithshouldermotionanalysis AT gianmariomicheloni reverseshoulderarthroplastyinobstetricbrachialplexusinjuryourexperiencewithshouldermotionanalysis AT luigitarallo reverseshoulderarthroplastyinobstetricbrachialplexusinjuryourexperiencewithshouldermotionanalysis |