Clinical Research Directory

Kinematic Analysis of Latissimus Dorsi Transfer Results for Shoulder External Rotation Resuscitation

Neonatal brachial plexus palsy is a pathology that remains common and one of its sequelae is lack of external rotation of the shoulder. One of the treatments to increase this range of motion is the transfer of the latissimus dorsi tendon to the infraspinatus muscle. The aim of this study is to analyze the long-term three-dimensional kinematic effects of latissimus dorsi transfer with or without subscapularis release on upper limb joints during the five Mallet tasks and their correlation with clinical and MRI parameters. Predictive factors such as age at the time of the operation, the extent of the damage and the presence of severe preoperative dysplasia, the presence of neosurgery and the age at which this neosurgery was performed will be evaluated. The main objective is to evaluate the benefit of releasing the subscapularis during latissimus dorsi transfer surgery in patients with neonatal brachial plexus. This evaluation is done through an analysis of the movement of the upper limb in three dimensions. Kinematic data will be compared between patients with subscapularis release, patients without subscapularis release, and an existing database of unaffected arms. The secondary objective is to study the correlation between kinematic data and factors that may influence results such as age at the time of surgery, extent of plexus damage, presence of severe preoperative dysplasia , the presence of neosurgery and the age at which this neosurgery was performed. The collection will be done during a single movement analysis session, in a dedicated room at Trousseau hospital, for a duration of approximately 1 hour and 30 minutes. Part of the equipment designed and manufactured by the Ecole Nationale Supérieure d'Arts et Métiers (ENSAM) for these analyzes will be permanently installed in the analysis room. Other equipment will be installed just before the measurement session and put away at the end. The installation of analysis and measurement equipment as well as the acquisition of data during movements are carried out by ENSAM teacher-researchers or students. The patient is welcomed into the room by a clinician involved in the study and who will participate in the entire session. In particular, he will carry out a rating of the Mallet score at the start of the session, the placement of sensors for movement analysis, palpation of anatomical points and will give the patient instructions for carrying out the movements.