Posterior Dislocation of The Glenohumeral Joint Associated With Obstetrical Brachial Plexus Palsy In Children Since Birth to twelve years

1. Teres major and Latissimus Dorsi to infraspinatus transfer is a useful procedure for correction of defective shoulder abduction and external rotation in obstetrical brachial plexus palsy (OBPP)., The basic advantages of this procedure over other tendon transfers are, it increases the stabilizing action of the rotator cuff thus allows the deltoid to act with maximal force, also in this position it increases both shoulder abduction and external rotation and it increases the lever arm of external rotation as the diameter of the head is larger than the diameter of the shaft.2. The operation is best performed under the age of two years to get maximal improvement the shoulder range of motion and to prevent secondary bony changes in the form of glenoid retroversion and posterior subluxation of the humeral head in our opinion.3. Between the age of 2-4 years, the operation also resulted in significant improvement in the shoulder range of motion and prevention of glenoid retroversion but did not prevent posterior subluxation of the humeral head.4. After the age of 4 years, the improvement in the shoulder range of movement was not significant and the operation did not prevent the evolution of significant secondary bony changes.5. CT is mandatory for diagnosis of glenohumeral deformities.6. Early reduction and correction of the deformities happened, makes a high possibility for remodeling to take place.7. Dislocation of the humeral head should be considered in any infant or child who has Erb obstetrical paralysis.8. Thorough follow-up is also necessary for children after successful reduction of the shoulder, because of the risks of later recurrence of deformity or of late onset of stiffness caused by fibrosis of the capsule and ligaments and by imperfect remodeling of the head of the humerus and of the glenoid.9. An internal rotation contracture secondary to brachial plexus birth palsy has a high likelihood of being associated with glenoid deformity. For patients who have such a contracture, we recommend early imaging of the shoulder with CT or MRI.10. Open reduction of the glenohumeral joint in children who have paralytic dislocation of the shoulder due to muscle imbalance secondary to brachial plexus palsy is effective and improved the function of the shoulder even in very late cases and release of the contracted muscles enabled us to perform the reduction easily.