Clinical and functional outcomes of arthroscopic release with or without latissimus dorsi tendon transfer in obstetric brachial plexus palsy.

Abstract

Internal rotation contractures of the shoulder are common sequelae of obstetric brachial plexus palsy (OBPP) and can markedly impair upper limb function. Although arthroscopic capsular release improves passive range of motion (ROM), tendon transfer may be needed to improve active external rotation and abduction. This study compared clinical and functional outcomes after isolated arthroscopic release versus arthroscopic release combined with latissimus dorsi tendon transfer. Thirty-two pediatric patients surgically treated for OBPP-related shoulder contracture between 2018 and 2024 were retrospectively analyzed. Group A (n = 18) underwent isolated arthroscopic capsular release, whereas group B (n = 14) underwent arthroscopic release with simultaneous latissimus dorsi tendon transfer. In all patients, the subscapularis muscle was preserved, and only the anterior capsule was released. ROM and functional test scores (hand-to-neck, hand-to-abdomen, hand-to-mouth) were assessed preoperatively and at 1-year follow-up by the same clinician. Both groups demonstrated significant postoperative improvements in shoulder ROM. External rotation and abduction increased significantly in both groups, with a greater abduction gain in group B (P = 0.007). Internal rotation was preserved postoperatively in both groups and improved significantly in group A (P = 0.011). Functional scores showed mild improvements in both groups, but none reached statistical significance. Arthroscopic capsular release is an effective, minimally invasive option for shoulder contractures secondary to OBPP. In appropriately selected patients, simultaneous latissimus dorsi tendon transfer may provide additional improvement in active shoulder abduction without causing a clinically relevant loss of internal rotation. Preservation of the subscapularis muscle helps maintain postoperative internal rotation function.