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Late Aspects

With time, the results do not always improve. Either after surgery when the physiotherapy is not maintained or the arm is « forgotten », or in untreated cases, the pre-adolescent period is dangerous: the particular anomalies become definitive, the muscle and capsular retractions intractable.

It is at the end of the growing period that these sequelae are obvious; the shoulder is internally rotated, often there is a posterior dislocation with severe deformities of the joint.

The elbow is usually flexed, sometimes severely and the biceps is globular. The forearm may be either in pronation or in supination. This supination contracture is very disabling. The hand itself may be very poor, especially if it lacks wrist extension and fingers flexion.

The appearance may be obvious, with a shortening of the upper extremity. The length discrepancy is related to the extent of the paralysis and the delay of recovery: The earlier the treatment, the less shortening will occur.

Some patients with severe shoulder dysplasia may experience arthritic degeneration with pain quite early (16-19 years old).

It is still possible in these late cases to improve the function and cosmesis of the limb by a rotation osteotomy of the humerus.

The main difficulty is the lack of use of the upper extremity after so many years and even with surgical rehabilitation, the function will stay limited.