Browns syndrome

Question 1

General

Answer 1

Limited elevation in adduction

down drift on contralateral version

Re > Le

overreaction of contralateral SR in a an A or V pattern

Discomfort on attempted elevation and adduction

+ve force version test

Question 2

Cover test

Answer 2

mechanical deviation

small vertical in primary position

Question 3

Aetiology

Answer 3

Tendon sheath abnormalities

tendon abnormalities

Trauma / inflammatory arthritis

Diff diagnosis: congenital infammatory oblique palsy

in congenital aetiology unconformed

Question 4

Management

Answer 4

If BSV in primary position then left alone

surgery only if decompensation in primary position- acquired cases may require underlying aetiology be treated

conservative - observe and cortical steroids

surgery - split tendon lenghtening, tenectomy sup oblique