Addressing Residual Shoulder Deformities in Birth Brachial Plexus Palsy: Mod Quad Release Revisited

Abstract

Birth brachial plexus palsy is not an uncommon condition. Despite spontaneous recovery in most cases, some residual deformities do exist in the upper limb. Out of these deformities, a decreased range of movement in the shoulder (abduction and external rotation) is common. To improve shoulder abduction and external rotation, the procedure described are Mod Quad procedure which includes the release of pectoralis major and minor muscles, transfer of latissimus dorsi and teres major to teres minor muscle, and axillary nerve neurolysis which is based on the principle of releasing the contracted muscles and augmenting the paralytic muscles. Although it is a simple technique, gives early results, and is easy to reproduce, but less details are available in the literature. The present article aims to revisit the Mod Quad procedure, doing a comprehensive review of its pros and cons, technical considerations, and outcome analysis