Humeral retroversion and shoulder muscle changes in infants with internal rotation contractures following brachial plexus birth palsy

• 作者: Fabian van de Bunt Johannes A van der Sluijs Michael L Pearl Tom van Essen
• 来源期刊: 世界骨科杂志(英文版)
• 学科: 医学
• 关键词: HUMERAL retroversion INFANTS BRACHIAL PLEXUS BRACHIAL PLEXUS neuropathies SHOULDER Humerus
• 年，卷（期）: 2018,（12）
• 页码范围: 292-299
• 页数: 8页
• 分类号: R

摘要

AIM To examine humeral retroversion in infants who sustained brachial plexus birth palsy(BPBI)and suffered from an internal rotation contracture.Additionally,the role of the infraspinatus(IS)and subscapularis(SSc)muscles in the genesis of this bony deformation is explored.METHODS Bilateral magnetic resonance imaging(MRI)scans of 35 infants(age range:2-7 mo old)with BPBI were retrospectively analyzed.Retroversion was measured according to two proximal axes and one distal axis(transepicondylar axis).The proximal axes were:(1)the perpendicular line to the borders of the articular surface(humeral centerline);and(2)the longest diameter through the humeral head.Muscle cross-sectional areas of the IS and SSc muscles were measured on the MRI-slides representing the largest muscle belly.The difference in retroversion was correlated with the ratio of muscle-sizes and passive external rotation measurements.RESULTS Retroversion on the involved side was significantly decreased,1.0°vs 27.6°(1)and 8.5°vs 27.2°(2),(P<0.01),as compared to the uninvolved side.The size of the SSc and IS muscles on the involved side was significantly decreased,2.26 cm^2 vs 2.79 cm^2 and 1.53 cm^2 vs 2.19 cm^2,respectively(P<0.05).Furthermore,the muscle ratio(SSc/IS)at the involved side was significantly smaller compared to the uninvolved side(P=0.007).CONCLUSION Even in our youngest patient population,humeral retroversion has a high likelihood of being decreased.Altered humeral retroversion warrants attention as a structural change in any child being evaluated for the treatment of an internal rotation contracture.