Kaiser Permanente Physician Improves Procedure to Repair Shoulder Injuries Suffered During Birth.

LOS ANGELES -- Kaiser Permanente Southern California physician, Michael Pearl, M.D., has developed a novel arthroscopic technique to treat a debilitating condition called brachial plexus birth palsy that limits the function of children.

The paper is published in the March 2006 edition of the Journal of Bone Joint Surgery (Am).

"This paper shows that when we use arthroscopy, we are not only doing a much less invasive procedure, but we can do a much better job of correcting the imbalance between the muscles, tendons, bones and joints," said Dr. Pearl, of the Kaiser Permanente Los Angeles Medical Center.

Brachial plexus birth palsy is caused by stretching between the infant's head and shoulders during the birth process that occasionally (about one in 500 births) results in injures to the nerves and muscles of the hand and arm.

Treatment usually begins with range of motion exercises to keep the infant's muscles and joints limber while the damaged nerves are healing. Physical and/or occupational therapy may also be helpful.

"In severe cases, surgery may be performed in the first year of life to repair damaged nerves," said Pearl. "However, even in the best cases, this does not result in a normal arm. Later, other surgeries may be necessary to release stiff joints and reposition muscles or correct deformities."

The brachial plexus nerves conduct signals from the spine to the shoulder, arm, and hand. Symptoms of the condition can include limpness or paralysis, and reduced or absent sensation.

"This treatment method has shown dramatic improvements in joint deformities that were thought uncorrectable, as reported by other investigators in the April 2005 issue of the same journal," said Pearl. "Although most brachial plexus injuries heal without treatment and many children recover by three to four months of age without surgical treatment, we are glad we can provide an option for the children who need help."

Arthroscopy refers to treatment of knee, ankle, shoulder, elbow, and carpal tunnel injuries including rotator cuff disorders, carpal tunnel syndrome, joint replacement and cartilage grafting.

Kaiser Permanente is America's leading integrated health plan. Founded in 1945, it is a nonprofit, group practice prepayment program with Southern California headquarters in Pasadena, California. Kaiser Permanente serves the health care needs of 3.2 million members in Southern California. Today it encompasses the nonprofit Kaiser Foundation Health Plan, Inc., Kaiser Foundation Hospitals and their subsidiaries, and the for-profit Southern California Permanente Medical Group. Kaiser Permanente's Southern California Region includes more than 49,919 technical, administrative and clerical employees and caregivers, and more than 6,000 physicians representing all specialties.

www.kaiserpermanente.org