Results of Anterior Should er Release for Residual Contractures in Erb s Palsy

Background: In children with Erb s palsy who do notrecover fully, the most common residual deformity is internalrotation-adduction contracture of the shoulder.Objective: Surgical correction of this contracture byanterior shoulder release is described in this paper.Design: Twelve consecutive children (eight boys and fourgirls) with Erb s palsy were treated in this study in ouruniversity hospital. They all had a fixed internal rotationcontracture and limitation of shoulder abduction the right armwas affected in 10 children while the left was affected in 2children. Age range at the time of surgery was from three tosix years (average of 5 years). Eight of the palsies involvedthe fifth and sixth cervical nerve roots and four involved the fifth, sixth and seventh cervical nerve roots. The mean durationof follow-up was three years (range 1.5 to 4 years).Method: The operation was performed through a verticalincision in the line of the anterior axillary fold. The deltopectoralgroove was identified and the pectoralis major tendondefined. The pectralis major was lengthening by dividing theanterior and posterior portion of its tendon of insertion atdifferent levels and then suturing them to one another in alengthened position before closure. The subscapularis tendonand the capsule were divided also. After the soft tissue release,the correction was easily accomplished by external rotationof the arm.Result: During the follow up period, there have been norecurrence of deformity and all the children are free of anyshoulder orthosis. With Mallet scoring all patients had anaverage improvement of 1.2 grades for abduction, 1.6 gradesfor external rotation, 1.6 grades for hand to mouth ability and1.4 grades for hand to neck ability, internal rotation contracturewas improved in all patients.Conclusion: Anterior soft tissue release of the shoulderin children with Erb s palsy is an effective method for correctionof internal rotation and adduction contracture.