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International Orthopaedics
Published in: International Orthopaedics 2/2015

01-02-2015 | Original Paper

A modified Sever-L’Episcopo procedure for restoration of shoulder joint function in Erb’s palsy

Authors: Rabea Odeh, Munzir Odeh

Published in: International Orthopaedics | Issue 2/2015

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Abstract

Purpose

The aim of this study was to analyse the clinical outcome of a modified Sever-L’Episcopo technique for release of contracted muscles and tendon transfer to restore function of the shoulder joint in patients with Erb’s palsy.

Methods

A case series was conducted from March 1988 to November 2009 for 19 patients. The average age at operation was 8.4 years. A single incision via an anterior approach to the shoulder joint was used. Elongation of the pectoralis major and subscapularis was carried out. Excision of most of the coracoid process was performed. Latissimus dorsi and teres major muscles were transferred from their insertion on the anteromedial aspect to the lateral aspect of the humerus via passing posteriorly to the shaft of the humerus. Anterior capsulotomy was done as needed to get concentric reduction of the glenohumeral joint.

Results

According to the modified Mallet classification, there was improvement in glenohumeral joint movement, with a total score increase from 11.5 to 20.1. The improvements of abduction and external rotation were statistically significant with a p value of less than 0.005 through application of the paired t test, comparing preoperative with postoperative values.

Conclusions

Our modified technique in tendon transfer in treatment of Erb’s palsy has led to improvement in glenohumeral joint function. This procedure can be applied efficiently in patients up to 16 years of age.
Literature
1.
Smellie W (1764) Collection of preternatural cases and observations in midwifery. Completing the design of illustrating his first volume on that subject, 3rd edn. Wilson and Durham, London, p 504
2.
Duchenne GBA, Balliere JB (1872) De L’électrisation localisée et de son application à la pathologie et à la thérapeutique; 357–62
3.
Erb W (1874) Über eine eigenthümliche Lokalisation von Lähmungen im Plexus brachialis. Verh Naturist Med Ver 1:130
4.
Dejerine-Klumpke A (1885) Contribution à l’étude des paralysies radiculaires du plexus brachial. Paralysies radiculaires totales. Paralysies radiculaires inférieures. De la participation des filets sympathiques oculo-pupillaires dans ces paralysies. Rev Med Vet (Toulouse) 5:591–616, 739–90
5.
Zancolli EA, Zancolli ER (1988) Palliative surgical procedures in sequelae of obstetric palsy. Hand Clin 4:643–669PubMed
6.
Gherman RB, Ouzounian JG, Satin AJ, Goodwin TM, Phelan JP (2003) A comparison of shoulder dystocia-associated transient and permanent brachial plexus palsies. Obstet Gynecol 102(3):544–548PubMedCrossRef
7.
Fairbank HAT (1913) Birth palsy: subluxation of the shoulder joint in infants and young children. Lancet 1:1217–1223
8.
Sever JW (1927) Obstetrical paralysis. Surg Gynecol Obstet 44:547–549
9.
L’Episcopo JB (1934) Tendon transplantation in obstetrical paralysis. Am J Surg 25:122–125CrossRef
10.
Hoffer MM, Phipps GJ (1998) Closed reduction and tendon transfer for the treatment of dislocation of the glenohumeral joint secondary to brachial plexus birth palsy. J Bone Joint Surg Am 80:997–1001PubMed
11.
Green WT, Tachdjian MO (1963) Correction of residual deformities of the shoulder in obstetrical palsy. J Bone Joint Surg Am 45-A:1544
12.
Waters PM, Smith GR, Jaramillo D (1998) Glenohumeral deformity secondary to brachial plexus birth palsy. J Bone Joint Surg Am 80:668–677PubMed
13.
Mallet J (1972) Obstetrical paralysis of the brachial plexus. II. Therapeutics. Treatment of sequelae. Priority for the treatment of the shoulder. Method for the expression of results (in French). Rev Chir Orthop Reparatrice Appar Mot 58(Suppl 1):166–168PubMed
14.
Bahm J, Ocampo-Pavez C, Disselhorst-Klug C, Sellhaus B, Weis J (2009) Obstetric brachial plexus palsy: treatment strategy, long-term results, and prognosis. Dtsch Arztebl Int 106(6):83–90PubMedCentralPubMed
15.
El-Gammal TA, Saleh WR, El-Sayed A, Kotb MM, Imam HM, Fathi NA (2006) Tendon transfer around the shoulder in obstetric brachial plexus paralysis: clinical and computed tomographic study. J Pediatr Orthop 26(5):641–646PubMedCrossRef
16.
17.
Covey DC, Riordan DC, Milstead ME, Albright JA (1992) Modification of the L’Episcopo procedure for brachial plexus birth palsies. J Bone Joint Surg Br 74(6):897–901PubMed
18.
Edwards TB, Baghian SP, Faust DC, Willis RB (2000) Results of latissimus dorsi and teres major transfer to the rotator cuff in the treatment of Erb’s palsy. J Pediatr Orthop 20:375–379PubMed
19.
Vasiu PS, Hess AV, Grogan DP (2000) Sever-L’Episcopo tendon transfer in obstetric brachial plexus palsy. J South Orthop Assoc 9(1):8–12PubMed
20.
Waters PM, Bae DS (2006) The effect of derotational humeral osteotomy on global shoulder function in brachial plexus birth palsy. J Bone Joint Surg Am 88:1035–1042PubMedCrossRef
Metadata
Title
A modified Sever-L’Episcopo procedure for restoration of shoulder joint function in Erb’s palsy
Authors
Rabea Odeh
Munzir Odeh
Publication date
01-02-2015
Publisher
Springer Berlin Heidelberg
Published in
International Orthopaedics / Issue 2/2015
Print ISSN: 0341-2695
Electronic ISSN: 1432-5195
DOI
https://doi.org/10.1007/s00264-014-2592-7

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