• Syed Kamran Ahmed
  • Pervaiz Mehmood Hashmi


Background: Children with erb’s palsy have significant functional disability, mainly related tothe shoulder. The objective of this study was to analyze the functional outcome of tendon transfersperformed for restoration of shoulder motion in patients with Erb’s palsy. Methods: Thisdescriptive case series was conducted at Aga Khan University Hospital from May 1999 toDecember 2003. Ten patients who had functional deficit of shoulder elevation were operated by asingle surgeon.. The surgical procedure; modified Sever L’Episcopo procedure was uniform in allcases. The data was collected through patient interviewing and medical records maintainedthrough Health Information Management System (HIMS). Mallet class was recordedpreoperatively and postoperatively. Results: Ten patients; seven females (70%) and three males(30%), with average age of 75 months at operation were included in this series. Right shoulderwas affected in seven cases (70%) while left in three cases (30%). Preoperative mallet class forglobal abduction improved from 3 to 4; for global external rotation from 2 to 4 and for ability tobring the hand to mouth and neck from 1 to 3. Post operatively mallet class improved in all aspectsto 4 and 5; statistically significant on paired t-test with p value of less than 0.005. There was asignificant improvement in abduction, forward flexion and external rotation as compared topreoperative values; statistically significant on paired t-test with p value of less than 0.005.Conclusion: Tendon transfer improves the functional status of shoulder in late cases of Erb’sPalsy with significant improvement in mallet class, cosmesis and patient satisfaction. A motivatedpatient, compliance and aggressive rehabilitation are important outcome parameters.Keywords: Erb’s palsy, Modified Sever L’Episcopo procedure, Mallet class, Putti sign


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