الفهرس 
Criteria for considering studies for this reviewOnly 14 pages are availabe for public view
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Abstract
Background: Shoulder internal rotation contracture, active abduction and external rotation deficits are frequent secondary complications observed in children with obstetric brachial plexus palsy (OBPP). Soft tissue shoulder operations are often done for treatment as arthroscopic capsular release and open subscapularis recession. There is a lack of studies regarding the subscapularis recession and also regarding the comparison between the two techniques.
Aim of the Work: to review systematically and meta-analyze the currently available literature regarding arthroscopic capsular release (ACR) and open subscapularis recession (OSR) in internal shoulder contracture in OBPP regarding the clinical efficacy and complications.
Methods: A literature search pooled the studies pertaining to the children with OBPP in early age treated with ACR and OSR. A systematic review and meta-analysis was conducted to assess the success rates of the two techniques using the Mallet score. We excluded the studies or the patients with history of any concomitant surgical interventions e.g.: humeral osteotomy, tendon transfer.
Results: Data from eight studies (152 patients) were compiled for our meta-analysis. The mean follow-up duration was 23.87 months with average age 2.4 years. The standardized difference in means (SMD) for the active abduction (ABD.) score was 0.59 for the ACR in comparison to the OSR (SMD= 0.427). The SMD regarding the ACR was 1.22 in passive abduction, 1.68 in passive external rotation (ER) in ABD. , 2.31 in passive ER in adduction, 2.38 in hand to mouth, 2.67 in hand to neck, -0.49 in hand to spine, 2.84 in total Mallet score, 3.18 in the active ER (in comparison to the OSR the SMD was 0.427) and -2.06 in active internal rotation (in comparison to the OSR the SMD was 0.128). Recurrence of internal shoulder contracture was documented in 8 of 93 children after ACR and regional pain syndrome with shoulder stiffness was reported in only on case out of 28 cases after ACR.
Conclusion: In this study, we found that the ACR is highly effective than the OSR technique regarding the functional outcome of the shoulder in all the Mallet score items except in hand to spine and internal rotation. The ACR shows more advantages than OSR intra-operatively regarding soft tissue identification and post-operatively regarding scarring and infection, but with higher risk of recurrence and axillary nerve injury.