Orthopedic Interventions
Brachial plexus birth palsy patients present either in infancy (early BPBP) or in later part of life (Residual BPBP). We offer comprehensive care and counselling to Brachial plexus birth palsy patients at any age of presentation. Till date we have managed more than 500 children with Obstetric brachial plexus palsy all over the country.
The spectrum of orthopaedic interventions we perform at CBPC include:
Botox Type-A Injection: It is offered in young children with co-contractions between various cross-innervated muscles. Botox is injected in Pectoralis Major and Subscapularis in cases of co-contractions between Internal Rotators/Adductors and External Rotators/Abductors of shoulder limiting abduction and external rotation of shoulder. It is injected in triceps is injected I cases of co-contraction between biceps and triceps limiting elbow flexion.
It helps in decreasing future tendon transfer surgeries for shoulder to the extent of 50%. However, in cases where there is no recruitment of opposite group of muscles, tendon transfer is required later.
Before Surgery
After Surgery
A.B. was a 1.2 years old girl with restricted shoulder (arm) elevation. She was treated with botox therapy & her over head activities improved.
Shoulder Rebalancing Surgeries: The most commonly seen limitation in residual OBPP patients is shoulder abduction and external rotation. Releasing tight internal rotators and adductors (subscapularis, pectoralis major, latissimus dorsi and teres major) and strengthening week external rotators and abductors (supra spinatus and infra spinatus) is the most common surgical procedure performed worldwide. We do Minimally invasive subscapularis release (M.I.S.R) through a 1cm incision along with conjoint tendon transfer (Latissimus dorsi and Teres major) through a cosmetic axillary scar to provide significant functional improvement. M.I.S.R is the least invasive and safest technique of subscapularis release among all the techniques described with comparable or better results. It is pioneered by Dr Maulin Shah.
Trans positioning of clavicular head of pectoralis major is also performed in those subsets of patients who present with limitation of shoulder abduction. In case of severe limitation of shoulder abduction with deltoid paralysis, trapezius to deltoid transfer is performed.
Bony Procedures in Shoulder and Arm: Glenoid anteversion osteotomy is done in old cases of noncongrous gleno-humeral joints with glenoid retroversion and subluxation/dislocation of gleno-humeral joint. In cases of persistent internal rotation with good function of arm even after soft tissue procedures, derotation osteotomy of humerus is performed for cosmetic improvement of the arm
Elbow Rebalancing Surgeries: Flexion contracture is the most commonly abnormality seen at elbow in OBPP patients. We perform a myriad of procedures at elbow depending upon the requirement of the patient. Fractional lengthening of brachialis, triceps to biceps transfer, Steindler’s flexorplasty are a few to name.
Forearm Surgeries: Supination contractures of the forearm are commonly seen in OBPP patients. Biceps re-routing, Interosseous membrane release, distal radio-ulnar fusion in pronation and derotation osteotomy of radius and/or ulna are used to manage these rotational deformities depending upon the severity of the deformity.
Wrist and Hand Deformities: Flexion contractures of hand and fingers are commonly seen in cases of pan plexopathy. Green’s transfer is used in case of dynamic wrist flexion contractures whereas wrist and interphalangeal fusions are performed in case of severe deformities.