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Reverse shoulder arthroplasty in obstetric brachial plexus injury: our experience with shoulder motion analysis

BACKGROUND: Obstetric brachial plexus injury (OBPI) is a weakening or paralysis of the upper arm caused by brachial plexus injury followed by a muscle paralysis with severe repercussions on the movement of the shoulder joint following a progressive glenohumeral joint deformity. This case series anal...

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Autores principales: Porcellini, Giuseppe, Montemagno, Marco, Manzini, Chiara, Fiumana, Gabriele, Giorgini, Andrea, Micheloni, Gianmario, Tarallo, Luigi
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Springer International Publishing 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10638338/
https://www.ncbi.nlm.nih.gov/pubmed/37947898
http://dx.doi.org/10.1186/s10195-023-00736-0
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author Porcellini, Giuseppe
Montemagno, Marco
Manzini, Chiara
Fiumana, Gabriele
Giorgini, Andrea
Micheloni, Gianmario
Tarallo, Luigi
author_facet Porcellini, Giuseppe
Montemagno, Marco
Manzini, Chiara
Fiumana, Gabriele
Giorgini, Andrea
Micheloni, Gianmario
Tarallo, Luigi
author_sort Porcellini, Giuseppe
collection PubMed
description BACKGROUND: Obstetric brachial plexus injury (OBPI) is a weakening or paralysis of the upper arm caused by brachial plexus injury followed by a muscle paralysis with severe repercussions on the movement of the shoulder joint following a progressive glenohumeral joint deformity. This case series analyzes the clinical and radiological outcomes of reverse total shoulder arthroplasty (RSA) in OBPI patients with a follow-up of 2 years. MATERIALS AND METHODS: OBPI patients with secondary end-stage glenohumeral arthritis were enrolled in the study and they were treated with RSA. Patient demographics and clinical outcomes [Range of Motion (ROM), Visual Analog Scale (VAS), Oxford Shoulder Score (OSS)] were evaluated. A novel Shoulder motion analysis was carried out to investigate specific movement patterns of scapulothoracic movements in these patients. This study is a prospective cohort study. RESULTS: Four Patients (M: F = 1:3) were enrolled in the study, the mean age was 49.3 years (+ 2.75), the mean OSS (Oxford Shoulder Score) decreased from 48.8 (± 2.5) preoperatively to 18.30 (± 2.78), the mean VAS (Visual Analog Scale) decreased from 7.25 (± 0.5) to 1.7 (± 0.3) in the follow up (∆% relative pain reduction:− 76.5%), Shoulder ROM obtained an improvement (p < 0.05) except for abduction and external rotation. The average follow-up time was 26.3 months (+− 4.5). Shoulder motion analysis showed a complete loss of the scapular tilting above 90 degrees of flexion compared to the typical one of standard RSA with a pattern shifted towards scapular retraction (engaging trapezius and rhomboid muscles) to compensate the loss of the posterior tilting. CONCLUSIONS: RSA in OBPI patients demonstrated a significant improvement of pain symptoms and a moderate improvement in daily activities, anyway with a more appreciable quality of life over time even if the marked hypotrophy especially of the posterior shoulder muscles showed some limits in maintaining suspension of the upper limb and a minor external rotation, with an internal rotation attitude during the movements. Level of evidence: Level IV, Case series.
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spelling pubmed-106383382023-11-11 Reverse shoulder arthroplasty in obstetric brachial plexus injury: our experience with shoulder motion analysis Porcellini, Giuseppe Montemagno, Marco Manzini, Chiara Fiumana, Gabriele Giorgini, Andrea Micheloni, Gianmario Tarallo, Luigi J Orthop Traumatol Original Article BACKGROUND: Obstetric brachial plexus injury (OBPI) is a weakening or paralysis of the upper arm caused by brachial plexus injury followed by a muscle paralysis with severe repercussions on the movement of the shoulder joint following a progressive glenohumeral joint deformity. This case series analyzes the clinical and radiological outcomes of reverse total shoulder arthroplasty (RSA) in OBPI patients with a follow-up of 2 years. MATERIALS AND METHODS: OBPI patients with secondary end-stage glenohumeral arthritis were enrolled in the study and they were treated with RSA. Patient demographics and clinical outcomes [Range of Motion (ROM), Visual Analog Scale (VAS), Oxford Shoulder Score (OSS)] were evaluated. A novel Shoulder motion analysis was carried out to investigate specific movement patterns of scapulothoracic movements in these patients. This study is a prospective cohort study. RESULTS: Four Patients (M: F = 1:3) were enrolled in the study, the mean age was 49.3 years (+ 2.75), the mean OSS (Oxford Shoulder Score) decreased from 48.8 (± 2.5) preoperatively to 18.30 (± 2.78), the mean VAS (Visual Analog Scale) decreased from 7.25 (± 0.5) to 1.7 (± 0.3) in the follow up (∆% relative pain reduction:− 76.5%), Shoulder ROM obtained an improvement (p < 0.05) except for abduction and external rotation. The average follow-up time was 26.3 months (+− 4.5). Shoulder motion analysis showed a complete loss of the scapular tilting above 90 degrees of flexion compared to the typical one of standard RSA with a pattern shifted towards scapular retraction (engaging trapezius and rhomboid muscles) to compensate the loss of the posterior tilting. CONCLUSIONS: RSA in OBPI patients demonstrated a significant improvement of pain symptoms and a moderate improvement in daily activities, anyway with a more appreciable quality of life over time even if the marked hypotrophy especially of the posterior shoulder muscles showed some limits in maintaining suspension of the upper limb and a minor external rotation, with an internal rotation attitude during the movements. Level of evidence: Level IV, Case series. Springer International Publishing 2023-11-10 2023-12 /pmc/articles/PMC10638338/ /pubmed/37947898 http://dx.doi.org/10.1186/s10195-023-00736-0 Text en © The Author(s) 2023 https://creativecommons.org/licenses/by/4.0/Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) .
spellingShingle Original Article
Porcellini, Giuseppe
Montemagno, Marco
Manzini, Chiara
Fiumana, Gabriele
Giorgini, Andrea
Micheloni, Gianmario
Tarallo, Luigi
Reverse shoulder arthroplasty in obstetric brachial plexus injury: our experience with shoulder motion analysis
title Reverse shoulder arthroplasty in obstetric brachial plexus injury: our experience with shoulder motion analysis
title_full Reverse shoulder arthroplasty in obstetric brachial plexus injury: our experience with shoulder motion analysis
title_fullStr Reverse shoulder arthroplasty in obstetric brachial plexus injury: our experience with shoulder motion analysis
title_full_unstemmed Reverse shoulder arthroplasty in obstetric brachial plexus injury: our experience with shoulder motion analysis
title_short Reverse shoulder arthroplasty in obstetric brachial plexus injury: our experience with shoulder motion analysis
title_sort reverse shoulder arthroplasty in obstetric brachial plexus injury: our experience with shoulder motion analysis
topic Original Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10638338/
https://www.ncbi.nlm.nih.gov/pubmed/37947898
http://dx.doi.org/10.1186/s10195-023-00736-0
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