الفهرس 
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Abstract
Obstetric brachial plexus injury remains a fairly common problem in newborns despite the improved obstetric care. The mechanism of injury is usually traction with lateral flexion of the head. Spontaneous recovery occurs in about 80-90% of the patients. However, incomplete recovery could lead to residual deformities of the shoulder, elbow, wrist, or hand. Children with shoulder deformity represent with limited shoulder external rotation and abduction. This is mainly due to an imbalance between the strong internal rotators and weak external rotators.
Treatment interventions aim to either augment external rotators strength via tendon transfer, or release of the contracture or correct glenohumeral subluxation by rotational osteotomy. The main goal of treatment is to regain functional range of motion of shoulder and guard against irreversible secondary bony changes.
As regarding tendon transfer, several techniques have been described in previous literature which all vary according to the tendon transferred and the site to which it is transferred to. However, latissimus dorsi and teres major transfer with or without anterior release or subscapulairis slide have been generally advocated by various authors as an effective treatment intervention to restore shoulder external rotation and abduction.
The aim of the work was to compare the effectiveness of transfer of latissimus dorsi versus teres major tendon with or without subscapularis slide in restoring shoulder external rotation and abduction in children with obstetric brachial plexus injury. The study included forty patients. Half of some had a latissimus dorsi transfer while the other half a teres major tendon transfer. The age of the patients ranged from 1.5 to 4 years with a mean of (2.94 ± 0.79) years. There were 24 females (60 %) and 16 males (40%). Left shoulder was affected in 21 patients (52.5 %) while right shoulder was affected in 19 patients (47.5%). 24 patients (60%) required a subscapularis slide.
At the end of the follow up, patients who had teres major transfer showed superior results with a mean gilbert score of (4.20±0.51) compared to a mean of (3.50±0.62) in patients who had a latissimus dorsi transfer. Limited internal rotation occurred in 18 patients (45%). Range of internal rotation improved after physiotherapy and had no overall functional impact.