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Glenoid anteversion, anterior subluxation of the humeral head, humeral head flattening, and external rotation contracture
6%
101/1631
Glenoid retroversion, posterior subluxation of the humeral head, and a round humeral head, with internal rotation contracture
7%
122/1631
Neutral glenoid, posterior subluxation of the humeral head, a flat humeral head, and internal rotation contracture
4%
73/1631
Glenoid retroversion, posterior humeral head subluxation, humeral head flattening, and internal rotation contracture
79%
1283/1631
Glenoid anteversion, posterior humeral head subluxation, humeral head flattening, and external rotation contracture
2%
33/1631
Select Answer to see Preferred Response
This presentation is consistent with an Erb's palsy. Persistent muscular imbalance across the shoulder is associated with glenoid retroversion, posterior humeral head subluxation, flattening of the humeral head, and overall instability. Obstetric Brachial Plexus palsies are typically a result of a stretch injury. In this particular scenario the baby has an Erb's palsy, which is characterized by injury to the C5 and C6 nerve roots (Upper Trunk of the Brachial Plexus). Classic presentation is an adducted and internally rotated shoulder, pronated forearm, and extended elbow ("waiter's tip). Erb's palsy has the best prognosis especially if the biceps and deltoid have anti-gravity function prior to 3 months. For those that do not recover, there is persistent muscular imbalance across the shoulder that can lead to glenoid retroversion, posterior humeral head subluxation, humeral head flattening, and an internal rotation contracture. Reading et al. retrospectively reviewed MRIs of 32 children with a known neonatal brachial plexus palsy and evaluated passive shoulder external rotation, Mallet scores and humeral head deformity both pre and post-operatively. They found that humeral head deformity and posterior subluxation was associated with glenoid version and there was no correlation between pre-operative measures and post-operative clinical outcomes. They concluded that humeral head deformity correlated with other glenohumeral dysplasia measures and deformity does not preclude a successful outcome. Hogendoorn et al. reviewed MRIs of 102 children with a neonatal brachial plexus palsy and evaluated various glenohumeral parameters. They found muscle degeneration was most prominent in the subscapularis, glenoid version correlated with structural changes in the subscapularis muscle, and posterior humeral head subluxation and glenoid shape correlated with rotator cuff abnormalities. They concluded that glenohumeral deformities are greater in those with C5-6 lesions. Incorrect Answers: Answers 1, 2, 3, and 5: Persistent muscular imbalance across the shoulder is associated with glenoid retroversion, posterior humeral head subluxation, humeral head flattening, and overall instability.
3.8
(5)
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