Remodelación de la articulación glenohumeral en la deformidad de tipo IV de la parálisis braquial obstétrica: Resultados clínicos y morfológicos luego de la liberación extraarticular del hombro y transferencia de los rotadores internos

background: persistent muscle imbalance of the shoulder rotator muscles leads to progressive glenohumeral joint deformity in brachial plexus birth palsy. our objective is to analyze the motor function and the effects at joint level after anterior extra-articular soft-tissue releases and tendon transfers of the internal rotators towards the external abductor/rotator muscles, in children with these sequelae. methods: we prospectively evaluated 8 patients under 4 years of age with water's type iv glenohumeral joint deformity, who underwent extra-articular releases and latissimus dorsi and teres major tendon transfers. the modified mallet classification system and the range of motion were used, together with 5 morphological measurements in the mri, before and after surgery with a 30 months follow-up. results: the mean aggregate modified mallet score improved from 13 to 18 points. mean active abduction improved 48o, and all patients improved their passive external rotation. all mri measurements improved significantly, except for 2 patients. conclusions: the anterior extra-articular soft-tissue releases and tendon transfers of the internal rotators towards the external abductor/rotator muscles, significantly improved the global shoulder function and the glenohumeral joint morphology without the need for open reduction and capsulorrhaphy.