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Diagnosis and Treatment of Shoulder Dysplasia

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How to detect these problems? How do you confirm the diagnosis of GHD? How to determine severity?

The IRCS and GHD are suspected because we cannot passively externally rotate the shoulder. The child has the forearm attached to the belly.


Figure 8.Observe how the child cannot get the forearm or hand out actively. Nor can we passively rotate the shoulder out.

To confirm the diagnosis of GHD, the best test is magnetic resonance imaging (MRI). Although this test requires sedation of the baby, MRI is needed to properly assess the severity of the deformity of the joint and to make the most appropriate treatment.



Figure 6. MRI. Cross section at the shoulders, showing the dislocation of the humeral head backwards (arrow on the right); compare with the other side. The head of the humerus (1) is smaller and dislocated, the scapula (2) is deformed and muscles (3 and 4) are less thick.

Ultrasound is progressively taking on more importance in the diagnosis and monitoring of the GHD.

Treatment of IRCS and GHD

The treatment used in cases where physical therapy fails to restore shoulder external rotation, is surgical. By arthroscopy, the subscapularis muscle is stretched and the shoulder is placed in external rotation for several weeks. This allows the shoulder joint to regain its original shape gradually. The main problem with this surgery is the loss of internal rotation, by weakening the subscapularis muscle. This condition may make it difficult to do activities in front of the body (for example, pulling up pants, hygiene, etc).

In recent years, we have treated some types of GHD without surgery, in order to prevent loss of shoulder internal rotation. Through the use of casts and braces that hold the shoulder in external rotation position, we avoid the complications associated with surgery.

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Diagnosis and Treatment of Shoulder Dysplasia
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