NEUROGENIC LESIONS AFTER POSTEROLATERAL THORACOTOMY IN YOUNG-CHILDREN

In follow-up examinations of young patients we often noticed upward di splacement of the left shoulder in cases where left-sided posterolater al thoracotomy had been carried out. Finding little discussion of this side-effect in the literature, we undertook the present study. The sh oulder girdle of 69 patients who had undergone surgery for coarctation of the aorta between 1964 and 1984 was carefully examined to assess d isplacements and dysfunctions. In addition, in 24 of the patients elec trodiagnostic examination was carried out of the associated muscles an d nerves which were affected by the operation. We found disturbances o f the muscular apparatus of the shoulder girdle in 80% of the cases: u pward displacement of the shoulder (55%), downward displacement of the shoulder (8.7%), deviation of the scapula at rest (72.5%) and maximal elevated arms (40.6%), scapula alata (56.5%), and alterations of the posterior axillary line (39.1%). When considering only the cases of di stinct upward or downward displacement of the shoulder, at least 25% o f the operated children were affected. Children operated early (surger y during the first year of life) had more distinct alterations (47.6%) than those with later surgery (14.6%). Electromyographic examinations indicate that mainly disorders of the peripheral nerves caused by the operation led to these alterations of the shoulder girdle musculature . Although, except for one patient, no functional disorders were found , there were several cases in which the alteration caused quite severe cosmetic problems. One should pay more attention to positioning for s urgery and do careful preparation to reduce these sequelae.