Purpose: Internal rotation contractures secondary to brachial plexus birth palsy (BPBP) frequently leads to glenohumeral deformity. Optimal treatment is in question, with recommendations ranging from open release of shoulder internal rotators to primary latissimus dorsi transfer. This is a report of 25 children that underwent arthroscopic contracture release.

Methods: Shoulder arthrocopy using a 2.7 mm arthroscope was performed on 25 children, aged 0.8 to 12 years, with internal rotation contractures. Pre-operative external rotation averaged –15° (range -60° to 45°). Pre-operative arthrograms were done in all cases and MRI in 18. Nine children received a release as an isolated procedure, 16 received a release along with latissimus dorsi transfer. Contractures were released with an electrocautery device releasing the subscapularis at its insertion and, when necessary, releasing the rotator interval (RI).

Results: Arthrography and MRI showed 13 concentric glenohumeral joints and significant deformity in the remaining 12. Arthroscopy showed corresponding intra-articular findings ranging from concentric, conforming joints to those with central ribbing of the glenoid that, in the most severe cases, developed into a bifid articular surface. The primary contracted elements were the subscapularis and RI tissue. Arthroscopic release was successful in achieving at least 45° of passive external rotation and a centered position of the glenohumeral joint in all but one case, the 12-year-old, who needed an open release. No complications were noted

Conclusions: Arthroscopic release appears at least as effective in achieving passive external rotation as open methods while providing excellent visualization of the glenohumeral joint and better cosmesis and decreased morbidity.