The Surgical Strategy to Correct the Rotational Imbalance of the Glenohumeral Joint after Brachial Plexus Birth Injury

In upper brachial plexus birth injury, rotational balance of the glenohumeral joint is frequently affected and contracture in medial rotation of the arm develops, due to a severe palsy or insufficient recovery of the lateral rotators. Some of these children present with a severe glenohumeral joint contracture in the first months, although regular physiotherapy has been provided, a condition associated with a posteriorly subdislocated or dislocated humeral head. These conditions should be screened early by a pediatrician or specialized physiotherapist. Both aspects of muscular weakness affecting the lateral rotators and the initial or progressive glenohumeral deformity and/or subdislocation must be identified and treated accordingly, focusing on the reestablishment of joint congruence and strengthening of the lateral rotators to improve rotational balance, thus working against joint dysplasia and loss of motor function of the shoulder in a growing child. Our treatment strategy adapted over the last 20 years to results from retrospective studies, including biomechanical aspects on muscular imbalance and tendon transfers. With this review, we confront our actual concept to recent literature.