Outcome of Tendon Transfer Around Shoulder with Erb's Palsy Internal Rotation Deformity

Abstract
Background: Obstetric Brachial Plexus Palsy (OBPP) is one of the most severe complications at birth with internal rotation deformity that have significant functional disability. There is a many different methods of tendon transfer that have been descried to improve the shoulder Range of Motion (ROM).
Aim of Study: Evaluate the outcome of teres major tendon transfer around the shoulder in children with Erb's palsy internal rotation deformity.
Methods: This study was Retrospective and prospective randomized clinical study carried out on totally (25) patients admitted to Orthopaedic Department of Tanta University Hospital. Ten children represented the Retrospective portion of the study, and fifteen represented the prospective portion. All cases were operated by Modified Sever-L'Episcopo tech-nique. The external rotation, according to Mallet score, was recorded pre-and post-operatively.
Results: The mean follow-up period was twelve months (range 6-18). The Mallet score for the shoulder external rotation, at the end of follow-up periods, was graded as Grade II in two patients (8%), Grade III in nine patients (36%), and Grade IV in fourteen patients (56%). There was a highly significant improvement (p=0.00001) of the external rotation range as the mean pre-operative score was 2.04±0.02, and the mean post-operative score was 3.48±0.65.
Conclusion: The Modified Sever L'Episcopo procedure that compromises of anterior release, then teres major tendon transfer to the tendon of infraspinatus shows a high incidence of good outcome with a promising subjective and objective improvement in almost cases.