shoulder adductor and internal rotator contracture release

Shoulder joint adduction and internal rotation muscle contraction for late limb function reconstruction of childbirth brachial plexus injury. The shoulder joint adduction and internal rotation contracture deformity is the most common shoulder sequelae of calving. The main internal rotation muscle of the shoulder joint - the subscapularis muscle is also dominated by the middle and the lower trunk while being dominated by the upper trunk, while the external rotation muscle of the shoulder joint - the infraspinatus muscle and the small round muscle are mainly affected by the C5 nerve root. Dominant. Because the pathological feature of calving is that the dry injury is lighter than the upper trunk, the compensatory recovery of the subscapularis muscle is significantly faster than that of the infraspinatus muscle and the small round muscle, which makes the balance between the active muscle and the antagonistic muscle, resulting in the shoulder joint. Produces an internal rotation contracture deformity. In addition to directly limiting shoulder abduction, the contracted subscapularis muscle mainly inhibits the function of the shoulder lift by limiting the external rotation of the humerus. With the development of the internal rotation contracture, the humeral head gradually shifts backwards until it is completely dislocated, which leads to a series of secondary changes such as excessive shoulder length and joint deformity, which makes the humeral head difficult to reset. The limited degree of passive external rotation of the shoulder joint can roughly reflect the development stage of the internal rotation contraction of the shoulder: 1 simple contracture, that is, the passive external rotation of the shoulder joint to about half of the normal value; 2 simple subluxation, that is, the passive external rotation of the shoulder joint To the neutral position; 3 full dislocation or complex subluxation, that is, the shoulder joint has a fixed internal rotation position. This can achieve early recognition of the internal fixation of the shoulder joint, and choose the appropriate surgical method to treat as soon as possible. Treatment of diseases: brachial plexus injury Indication Shoulder joint adduction and internal rotation contracture lysis is applicable to: 1. After the brachial plexus upper arm type injury, the residual shoulder joint internal rotation is deformed, and the active external rotation is <20° and the abduction is <60°. However, passive external rotation and abduction activities are close to normal. 2. The latissimus dorsi and the great round muscles have normal muscle strength and the muscle strength is above grade 3. 3. Age > 2 years old. Contraindications 1. The shoulder joint has been subluxated or dislocated. 2. Those with severe hand sensation and movement disorders. 3. The deltoid muscle strength is less than 3 levels. Preoperative preparation 1. Conventional shoulder joint X-ray of the lateral side, except for subluxation and dislocation of the shoulder joint. 2. If the shoulder joint has a severe internal contraction and contracture deformity, it should be practiced passively or with a series of cast orthopedics. Sometimes you have to do the pectoralis major muscles to stop the sputum release. This procedure is feasible when the passive external rotation of the shoulder joint is close to normal. Surgical procedure 1. Incision: Make an arc-shaped incision on the anterior medial side of the shoulder joint, that is, the anterior medial approach of the shoulder joint. From the condyle, down the deltoid pectoralis major intervertebral groove, stop at the proximal 1/3 of the humerus. Sometimes the proximal end of the incision must be extended to the acromioclavicular joint. 2. Cut the skin and subcutaneous tissue along the incision line, find the cephalic vein, and make a deltoid incision 0.5 cm outside the anterior edge of the deltoid muscle. Keep a deltoid fiber and the cephalic vein together to the inside to avoid damage to the cephalic vein. The blunt separation of the deltoid and pectoralis major muscles, and appropriate traction to both sides, can reveal the diaphragm, biceps brad, subscapularis and pectoralis major. 3. Cut the biceps brad and the tendon tendon at the condyle and turn it to the distal end to reveal the pectoralis major at the sacral nodule. 4. Expose and separate the pectoralis major tendon, which is the stop point of the lower part of the pectoralis major muscle fibers, which should be cut at the greater tibia. The deep tendon of the tendon is the tendon of the upper muscle fiber of the pectoralis major muscle, and it is cut off near the muscle abdomen, and the suture of the deep and shallow layers of the tendon is sutured to extend the pectoralis major tendon 4 to 5 cm. 5. Find the subscapularis tendon at the proximal humeral head, first bluntly free the muscle from the medial side and peel it off the joint capsule, taking care not to peel the joint capsule. Then use a sharp knife to cut the scapula under the tendon into two halves, that is, the sharp knife cuts from the inside to the humeral head. When the subscapularis muscle tendon is cut obliquely, the shoulder joint is allowed to perform abduction and external rotation. 6. Look for the latissimus dorsi and the great round muscle stop point in the lower part of the incision and the deep side of the pectoralis major tendon. The latissimus dorsi tendon is above and shallow on the large round muscle tendon. They are completely freed from the surrounding tissue, and then the two tendons are cut at the stop point, and the two tendons are overlapped, and the long and thick silk threads are used for intermittent suture, and the tail ends are not cut and fixed for fixation with the tibia. 7. Turn the sick child to the healthy side, and place the upper limb in the chest. A longitudinal incision is made between the deltoid muscle and the triceps, 7 to 8 cm long. Cut the skin and deep fascia, separate the deltoid and triceps gaps, and pull them to the sides, pay attention to careful operation to prevent damage to the phrenic nerve and phrenic nerve. Then, the periosteum was dissected longitudinally and the subperiosteal dissection was performed at the proximal metaphysis of the humerus, and the cortical bone of about 5 cm in the proximal end of the humerus was exposed. A 5 cm long bone groove was opened in the lateral cortical bone of the proximal humerus by hand drilling and a bone knife, and 4 bone holes were drilled from the lateral side to the medial side in the bone groove. The bone hole of the medial cortex should be in the original latissimus dorsi and the round muscle. The stop point. 8. Find the latissimus dorsi and the great round muscle in the anterior incision of the shoulder joint, and send it to the posterior incision, and then pass the tail line left by the latissimus dorsi muscle to the prefabricated bone hole from the outside to the inside. The suture is tightened from the anterior incision so that the tendon of the tendon enters the bone groove and is knotted and fixed. 9. Suture the subscapularis tendon, pectoralis major tendon, and biceps short head and tendon tendon in sequence. The above tendons should be sutured under prolonged conditions, so that there is no obvious tension when the shoulder joint is abducted and externally rotated. 10. After completely stopping bleeding, sew the skin incision layer by layer.

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