Shoulder Resources

Paediatric shoulder and elbow (R) Paediatric shoulder and elbow (R)

Glenoid hypoplasia

The glenoid develops from two ossification centres, which appear at 9 to 16 years of age. Glenoid hypoplasia is secondary to failure of the inferior ossification centre.
Glenoid hypoplasia is usually bilateral and symmetric.

• Primary
• Skeletal dysplasias
• Mucopolysaccharidoses
• Apert syndrome
• Holt Oram syndrome
• Cornelia de Lange syndrome

Patients present in the second or third decade with decreased ROM (particularly forward flexion) and sometimes multidirectional instability.

XR findings
The inferior glenoid and adjacent neck is not properly ossified. The coracoid and acromion are enlarged.
The humeral head is flattened and the humeral shaft is in varus.
CT arthrography and MRI show the inferior labrum is enlarged.

Natural history
Not known if this predisposes to later degeneration.

Rehabilitation programme

Septic arthritis of the shoulder

This is quite rare; only 5% of paediatric septic arthritis involves the shoulder.

Diagnosis is commonly late.
Pseudoparalysis is often seen. True paralysis may sometimes occur due to pressure on the brachial plexus.

A whole body bone scan should be obtained in neonates because multifocal osteomyelitis is common.

Natural history
Coexistent osteomyelitis often occurs because the proximal humeral metaphysis is intraarticular.
In neonates diagnosed 2 days or more after the onset of symptoms, damage to the physis and secondary ossification centres of the proximal humerus lead to shortening of the arm and deformity of the humeral head, but loss of function is negligible.


Clavicular birth fractures
Occur in 0.2% to 4.4%, much more common in vaginal deliveries (1.65% vs. 0.2%).
Fetal macrosomia and shoulder dystocia are common risk factors.
Concomitant brachial plexus injury is rare.

Proximal humeral fractures
Proximal humeral physeal fractures are uncommon, making up 3-6% of all physeal injuries.
The proximal humeral physis contributes 80% of the length of the humerus, and provides tremendous remodeling potential. Little functional impairment results from residual shortening or imperfect remodeling.
Thus, up to 70 degrees of angulation and 100% displacement can be accepted in children under 5, decreasing to 40 degrees of angulation and 50% displacement as the child nears physeal maturity.

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