Comprehensive review of shoulder complications in brachial plexus birth palsy, covering pathophysiology, clinical evaluation tools (Active Movement Scale, Mallet classification), imaging, and the full spectrum of surgical options — from arthroscopic contracture release and tendon transfer to humeral rotational osteotomy — for managing internal rotation contracture and glenohumeral dysplasia in children.
When you see a child with brachial plexus birth palsy and an internal rotation contracture, recognize that untreated capsular tightness — not just muscle weakness — drives irreversible glenohumeral dysplasia; early arthroscopic release targeting the subscapularis and anterior capsule, with latissimus dorsi transfer added in children over age 3, offers the best chance of both restoring external rotation and allowing the immature glenoid to remodel toward normal anatomy.
Comprehensive review of shoulder complications in brachial plexus birth palsy, covering pathophysiology, clinical evaluation tools (Active Movement Scale, Mallet classification), imaging, and the full spectrum of surgical options — from arthroscopic contracture release and tendon transfer to humeral rotational osteotomy — for managing internal rotation contracture and glenohumeral dysplasia in children.
When you see a child with brachial plexus birth palsy and an internal rotation contracture, recognize that untreated capsular tightness — not just muscle weakness — drives irreversible glenohumeral dysplasia; early arthroscopic release targeting the subscapularis and anterior capsule, with latissimus dorsi transfer added in children over age 3, offers the best chance of both restoring external rotation and allowing the immature glenoid to remodel toward normal anatomy.