L'Episcopo Reconstruction without Subscapularis Muscle Release for Residual Erb's Palsy Shoulder Deformity John T. Killian, MD, Orthopaedic Specialists of Alabama, Pediatric Orthopaedics, Birmingham, AL Incomplete recovery from Erb's palsy may result in limited glenhumeral external rotation and abduction along with posterior subluxation. Twenty patients were followed for their recovery from and Erb's birth palsy. All were involved in an occupational therapy program. Six patients developed a progressive posterior subluxation of the affected shoulder with an internal rotation contracture of 40-60 degrees. Three patients plateaued with a residual active shoulder abduction of 45-60 degrees and internal rotation contracture of more than 35 degrees. Nine patients underwent exam under anesthesia, lengthening of the pectoralis major and transfer of the conjoined tendon of the latissimus-teres to the posterior shoulder should capsule via an axcillary incision. No patient required a shoulder arthrotomy or subscapularis muscle lengthening to gain passive external rotation of the shoulder intra-operatively. Post operatively, all patients were in a "Statue of Liberty" shoulder spica for six weeks. Out patient therapy continued for 4-12 months post operatively. At follow-up, shoulders were rated for range of motion and congruency of reduction.