Shoulder release and tendon transfer following neonatal brachial plexus palsy: gains, losses, and midline function.

BACKGROUND: Shoulder release and tendon transfer is frequently performed to address persistent weakness from neonatal brachial plexus palsy. Although postoperative improvements in motion are well described, associated deficits are poorly documented and functional assessments are lacking. Loss of ability to reach midline can occur with surgery and may result in impairment. The purpose of this study was to comprehensively assess the gains, losses, functional changes, and patient reported outcome associated with our surgical approach. METHODS: Consecutive patients undergoing surgery with 2-year follow-up were included (n=30). Prospectively recorded assessments by therapists were reviewed. Changes were assessed by t-test and Wilcoxon rank sum (p<0.05). RESULTS: Active external rotation and abduction improved while internal rotation diminished. Aggregate modified Mallet score increased with improvements in all subscales except hand-to-spine was unchanged and hand-to-belly decreased. Functional assessment using the Brachial Plexus Outcome Measure revealed increase of aggregate score with no decline in any subscales. Improvements were in hand-to-back-of-head, forward-over-head-reach, holds-plate-with-palm-up, opening-large-container, and strings-bead. Aggregate patient self-report of appearance and function increased (18 to 23).Loss of ability to reach midline occurred in 3 patients (10%) who had extended Erb or total palsy and pre-operative limitations of internal rotation. CONCLUSIONS: Secondary reconstruction rebalances shoulder motion by increasing external rotation and abduction, while reducing internal rotation. In our study, a conservative surgical approach results in overall improvement in task-based abilities and self-reported outcomes, while preserving internal rotation within a functional range.