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      Imaging assessment of glenohumeral dysplasia secondary to brachial plexus birth palsy Translated title: Avaliação de imagens de displasia glenoumeral secundária a paralisia obstétrica do plexo braquial

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          Abstract

          Abstract Objective: To assess imaging parameters related to the morphology of the glenohumeral joint in children with unilateral brachial plexus birth palsy (BPBP), in comparison with those obtained for healthy shoulders. Materials and Methods: We conducted a retrospective search for cases of unilateral BPBP diagnosed at our facility. Only patients with a clinical diagnosis of unilateral BPBP were included, and the final study sample consisted of 10 consecutive patients who were assessed with cross-sectional imaging. The glenoid version, the translation of the humeral head, and the degrees of glenohumeral dysplasia were assessed. Results: The mean diameter of the affected humeral heads was 1.93 cm, compared with 2.33 cm for those of the normal limbs. In two cases, there was no significant posterior displacement of the humeral head, five cases showed posterior subluxation of the humeral head, and the remaining three cases showed total luxation of the humeral head. The mean glenoid version angle of the affected limbs (90-α) was -9.6º, versus +1.6º for the normal, contralateral limbs. Conclusion: The main deformities found in this study were BPBP-associated retroversion of the glenoid cavity, developmental delay of the humeral head, and posterior translation of the humeral head.

          Translated abstract

          Resumo Objetivo: Avaliar os parâmetros de imagem relacionados com a morfologia da articulação glenoumeral em crianças com paralisia obstétrica do plexo braquial (POPB) unilateral, comparando-os com os observados em ombros saudáveis. Materiais e Métodos: Foi realizada uma busca retrospectiva de casos de POPB unilateral diagnosticados em nossa instituição. Somente foram incluídos os pacientes com diagnóstico clínico de POPB unilateral, e a amostra final do estudo consistiu em 10 pacientes consecutivos avaliados por meio de imagens transversais. Foram avaliados a retroversão da cavidade glenoide, a translação da cabeça do úmero e o grau de displasia glenoumeral. Resultados: A média do diâmetro da cabeça do úmero foi 1,93 cm nos membros afetados e 2,33 cm nos membros normais. Em dois casos, não houve deslocamento posterior significativo da cabeça do úmero, cinco casos apresentaram subluxação posterior da cabeça do úmero, e os três casos restantes apresentaram luxação total da cabeça do úmero. A média do ângulo de retroversão glenoide dos membros afetados (90-α) foi -9,6º, ao passo que a dos membros contralaterais normais foi +1,6º. Conclusão: As principais deformidades encontradas neste estudo foram retroversão da cavidade glenoide relacionada com POPB, atraso no desenvolvimento da cabeça do úmero e translação posterior da cabeça do úmero.

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          The use of computerized tomography in the measurement of glenoid version.

          Computerized tomography was done preoperatively on twenty shoulders (thirteen patients) in which there were severe arthritic changes, to measure glenoid version. Ten of the twenty shoulders had osteoarthrosis; eight, rheumatoid arthritis; and two, gouty arthritis. To help determine normal values, computerized tomographic scans of the chest of sixty-three patients who did not have roentgenographic evidence of disease of the shoulder were studied retrospectively for comparison as a control group. In the group of patients who had severe arthritis, the mean glenoid orientation was 11 degrees of retroversion (range, 2 degrees of anteversion to 32 degrees of retroversion). The computerized tomographic scans showed uneven wear of the glenoid surface, osteophytes, large cysts, and posterior displacement of the humeral head. In the control group, the mean orientation of the glenoid was 2 degrees of anteversion (range, 14 degrees of anteversion to 12 degrees of retroversion). The difference between the groups was significant (p less than 0.0001). Glenoid retroversion was increased in the patients who had severe arthritis, and the computerized tomographic scans accurately revealed the extent and pattern of erosion of the bone.
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            Glenoid size, inclination, and version: an anatomic study.

            Three hundred forty-four human scapular bones (172 matched pairs) were measured for their glenoid height, width, inclination, and version. The sample consisted of 50 black men, 50 white men, 50 black women, and 22 white women, all of whom were aged 20 to 30 years at the time of death. The mean age of the study group was 25.6 years. No difference in glenoid size was noted between black and white patients. The overall glenoid version for the entire study group was 1.23 degrees of retroversion. The difference in glenoid version between black and white patients was statistically significant. The average glenoid version for black and white patients measured 0.20 degrees and 2.65 degrees of retroversion, respectively (P =.000014). Specifically, the glenoid version for black and white men measured 0.11 degrees and 2.87 degrees of retroversion, respectively (P =.00034). The glenoid version for black and white women measured 0.30 degrees and 2.16 degrees of retroversion, respectively (P =.034). No statistical difference in glenoid version was found between men and women of the same race. No difference was found between measuring the glenoid version based on the transverse axis of the scapula and measuring the glenoid version perpendicular to the glenohumeral joint. No statistical difference was found in the glenoid inclination based on race or sex. The relationships between glenoid size, inclination, and version are important to understand when a surgeon prepares to resurface the glenoid during total shoulder arthroplasty. The knowledge of these values, their variation, and racial differences should help reproduce a more anatomical result.
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              Glenohumeral deformity secondary to brachial plexus birth palsy.

              Ninety-four patients who had brachial plexus birth palsy were entered into a prospective study to evaluate the association between persistent palsy, age-related musculoskeletal deformity, and functional limitations. Of these patients, forty-two had either computerized tomography or magnetic resonance imaging to assess the presence and degree of incongruity of the glenohumeral joint, deformity of the humeral head, and hypoplasia of the glenoid as part of the preoperative planning for a reconstructive operation. Functional ability was rated with use of the classification of Mallet, on a scale of 1 to 5. The mean glenoscapular angle (the degree of retroversion of the glenoid) on the affected side was -25.7 degrees compared with -5.5 degrees on the unaffected side. Twenty-six (62 per cent) of the forty-two shoulders had evidence of posterior subluxation of the humeral head, with a mean of only 25 per cent (range, 0 to 50 per cent) of the head being intersected by the scapular line. Progressive deformity was found with increasing age (p < 0.001). The natural history of untreated brachial plexus birth palsy with residual weakness is progressive glenohumeral deformity due to persistent muscle imbalance. The status of the glenohumeral joint must be addressed when the choice between tendon transfer and humeral derotation osteotomy for reconstruction of the shoulder is considered for these patients.
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                Author and article information

                Contributors
                Role: ND
                Role: ND
                Role: ND
                Role: ND
                Role: ND
                Role: ND
                Role: ND
                Journal
                rb
                Radiologia Brasileira
                Radiol Bras
                Colégio Brasileiro de Radiologia e Diagnóstico por Imagem
                1678-7099
                June 2016
                : 49
                : 3
                : 144-149
                Affiliations
                [1 ] Universidade de Fortaleza Brazil
                [2 ] Universidade de São Paulo Brazil
                [3 ] Université Paris VI France
                [4 ] Harvard Medical School USA
                [5 ] União Médica Radiológica Catanduva Brazil
                [6 ] Universidade de São Paulo Brazil
                [7 ] Universidade de São Paulo Brazil
                Article
                S0100-39842016000300004
                10.1590/0100-3984.2015.0039
                c6641395-54bd-42d7-8d2d-ce82e687a6aa

                This work is licensed under a Creative Commons Attribution 4.0 International License.

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                SciELO Brazil

                Self URI (journal page): http://www.scielo.br/scielo.php?script=sci_serial&pid=0100-3984&lng=en
                Categories
                RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING

                Radiology & Imaging
                Birth injuries/complications,Joint diseases/diagnosis,Brachial plexus neuropathies/complications,Humeral head/abnormalities,Shoulder dislocation/diagnosis,Tomography,Traumatismos do nascimento/complicações,Artropatias/diagnóstico,Neuropatias do plexo braquial/complicações,Cabeça do úmero/anormalidades,Luxação do ombro/diagnóstico,Tomografia computadorizada

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