The experience in treating patients with the shoulder pathology due to brachial plexus injury at birth

Purpose. To develop the algorithms based on combining musculotendinous transpositions and osteoplastic interventions in the shoulder girdle in order to increase the active movements of abduction and supination in the shoulder in children with the consequences of the brachial plexus paralysis at birth. Materials and Methods. The authors examined 37 patients with the brachial plexus birth injury consequences. They used the methods of multispiral computed tomography (MSCT) and magnetic resonance imaging (MRI). Various-degree secondary changes in the shoulder components revealed in 26 patients. There were no changes in 11 patients according to the data of instrumented examinations. Hypoplasia, elevation and rotation of the scapula - SHEAR-deformity (Scapular Hypoplasia Elevation and Rotation) was considered as the secondary change; as well as the coracoid deformity characterized by the coracoid elongation, growth in the lateral direction; and the humeral head ovoid shape. Different variants of musculotendinous plasty surgery performed in 25 cases. Humeral derotation osteotomy performed in 6 cases. NeiSi-3M system of chronic electrical neurostimulation implanted in six patients with epineural electrode fixation to C5-C6 roots and their branches, to the inferior subscapular nerve, the suprascapular nerve, the axillary nerve, the musculocutaneous nerve. Orthoses for the shoulder used for some months in order to hold the shoulder in the predetermined position. Mallet scale used to evaluate the results of the performed treatment. Results. The best results were obtained in the group of the patients who underwent the surgery of humeral derotation osteotomy. The formation of abduction external-rotation contracture of the shoulder, the elevation and lateralization of the scapula, the combined movement of shoulder-scapula complex due to the scapula-thoracic junction - this observed in most patients who underwent surgical musculotendinous plasty. Conclusion. The efficiency of using a particular technique of treatment is determined by its reasonable selection in each specific case.