Long-term results of latissimus dorsi transfer for internal rotation contracture of the shoulder in patients with obstetric brachial plexus injury

BACKGROUND: This study evaluated the long-term outcome of patients with obstetric brachial plexus injury who underwent transfer of the latissimus/teres major tendon to restore shoulder external rotation and determined whether loss of internal rotation would affect their quality of life. METHODS: All patients with a history of obstetric brachial plexus injury who underwent latissimus dorsi transfer for internal rotation contracture were included. Results from 3 clinic visits (preoperative, and short-term and long-term postoperatively) were recorded. Quality of life was evaluated with a questionnaire. Internal rotation impairment was evaluated using the Activities of Daily Living which require active Internal Rotation scoring system. RESULTS: The study included 45 patients. At a mean 5 months postoperatively, shoulder motion was significantly improved in abduction and external rotation. This was associated with a significant loss of active internal rotation. These results deteriorated over time (at a mean 7.64 years postoperatively), especially in internal rotation (from being able to reach the sacrum to only being able to reach the trochanter) and in external rotation with the arm abducted. This decrease in function led 10 patients (22%) to undergo revision surgery. The mean score on the activities of daily living which require active internal rotation (ADLIR) at the last follow-up was 53. CONCLUSION: Although the short-tem results of latissimus dorsi transfer and subscapularis release are encouraging, these gains deteriorated over a longitudinal follow-up period. Abduction is maintained over the long-term, but external rotation deteriorates. Internal rotation deteriorated over a long-term longitudinal follow-up, leading to functional impairment.