Clavicle lengthening, a novel operation technique to reduce pain in brachial plexus birth injury patients

BACKGROUND: Brachial plexus birth injury (BPBI) can lead to an imbalance of shoulder musculature which can lead to glenohumeral contractures, joint and osseous deformities. Glenoid hypoplasia, lengthening of coracoid and acromion, protraction, lateral rotation and elevation of the scapula, and shortening of the clavicle can be observed. As a consequence, the trapezius, levator scapulae, rhomboid and supraspinatus muscles are overloaded in daily activities causing pain, which can be difficult to treat conservatively. It is hypothesized that operative lengthening of the clavicle, may lead to a more anatomical position of the scapula, and periscapular muscles, which as a consequence, may lead to less overloading pain. This study presents the results of this new technique in BPBI patients.

MATERIALS AND METHODS: 7 patients (median age 20 years) were included and underwent a lengthening osteotomy of the clavicle at the affective side. Preoperatively the osseous deformities were confirmed with a CT-scan. PROMs; DASH-Score and Mallet-Score were evaluated pre- and postoperatively.

RESULTS: After a median of 42 (IQR 8.0) months follow-up, all patients were satisfied with the result. The median Numeric Rating Scale (NRS) for satisfaction was 8.0 (IQR 2). Pain decreased from a median NRS of 7.0 (IQR 2) preoperatively, to 2.0 (IQR 3) at final follow-up. The median Mallet-Score was 14,5 (IQR 1) preoperatively and 14 (IQR 0) at final follow-up. The median DASH-Score was 36,7 (IQR 24,1) at final follow-up. All patients returned to their normal work without changes in working conditions.

CONCLUSION: Short term follow-up shows that, in BPBI patients with a short clavicle at the affected side and malposition of the scapula, a lengthening osteotomy of the clavicle is a safe and promising technique to reduce pain based on overloading, without deterioration of shoulder function.