Assessment of approaches to estimate scapular orientation in children with brachial plexus birth injury

Glenohumeral Dysplasia Following Brachial Plexus Birth Injuries: A Review

BACKGROUND AND OBJECTIVES

Despite the high morbidity associated with glenohumeral dysplasia (GHD) in children with brachial plexus birth injuries, the progression of this condition often remains unnoticed, even after correcting for the underlying brachial plexus birth injuries. GHD, driven by a multifactorial process involving disruptions in both direct and indirect neural regulation of bony and muscular structures, can lead to intermittent or permanent shoulder mobility imbalances, significantly impacting the quality of life of those affected. Recent research efforts are increasingly directed toward identifying the root causes, managing the deformity, and determining effective treatment options for correcting GHD.

METHODS

A comprehensive search strategy was used by the authors to identify relevant literature relating to the progression, pathoanatomy, clinical presentation, and management of GHD following brachial plexus birth injuries across various search engines, such as PubMed, Scopus, and Embase. Considering the topic's interdisciplinary nature, articles were retrieved from both neurosurgical and orthopaedic journals to enrich the review.

RESULTS

Given the challenges in managing patients with brachial plexus birth injuries, a multidisciplinary care team consisting of certified occupational hand therapists, neurosurgeons, plastic surgeons, and orthopedic surgeons, specializing in brachial plexus injuries should be advocated for. The aim of this collaborative effort is to correct brachial plexus birth injuries and prevent the persistence of GHD.

CONCLUSION

As research continues to focus on understanding the complexities of this condition, the aim of this review article is to summarize the current literature on the course of brachial plexus birth injury and the development of GHD. By doing so, we hope to provide neurosurgeons with the necessary knowledge and essential tools needed to identify and effectively treat GHD during management of brachial plexus birth injuries.

Three-Dimensional Upper Limb Movement Analysis in Children and Adolescents With Brachial Plexus Birth Injury: A Systematic Review

BACKGROUND

To synthesize the current evidence on clinical use of three-dimensional upper limb movement analysis (3D-ULMA) in children and adolescents with brachial plexus birth injury (BPBI).

METHODS

MEDLINE, Embase, and Web of Science were searched for relevant studies up to April 2022. An automatic e-mail alert was installed to ensure no eligible article was missed. Articles evaluating 3D-ULMA in children and adolescents with BPBI were included. Covidence web-based platform was used for blind screening of eligible articles. Twenty-one observational studies with a final sample size of 609, encompassing 493 BPBI cases, met the inclusion criteria. Data were extracted using a custom form to support standardized extraction conforming to the Cochrane Checklist of items. Risk of bias was assessed using the Newcastle-Ottawa Scale, the Strengthening the Reporting of Observational Studies in Epidemiology checklist, and a specifically established quality assessment form for kinematic analysis studies.

RESULTS

Study setups differed, including six different types of kinematic devices. Twelve studies used the (modified) Mallet positions for their 3D-ULMA. Throughout the studies, 3D-ULMA was used for various purposes. The Newcastle-Ottawa Scale scored 16 articles with five stars or more, indicating fair to moderate quality.

CONCLUSIONS

This systematic review summarizes the different 3D-ULMA kinematic devices, test protocols, and their clinical use for BPBI. The use of 3D-ULMA provides valuable, objective, and quantified data to clinicians with regard to movement strategies; it complements existing clinical scales and can be implemented to evaluate effectiveness of therapy interventions. Implications for future research and clinical practice are discussed.

Do Sex and Age Influence Scapular and Thoracohumeral Kinematics During a Functional Task Protocol?

There is mixed evidence on the role that biological sex plays in shoulder biomechanics despite known differences in musculoskeletal disorder prevalence between males and females. Additionally, advancing age may contribute to shoulder kinematic changes. The purpose of this study was to determine if sex and age influenced scapular and thoracohumeral kinematics during a range of functional tasks. Sixty healthy participants aged 19-63 years (30 males; 30 females) completed a functional task protocol while their upper limb motion was recorded. Scapular and humeral angles were calculated and compared with multiple linear regressions to assess the interaction effects of sex and age. Shoulder kinematics were not different between sex and age groups for many of the functional tasks. However, females had lower humeral external rotation in the overhead lift task (15°, P < .001), and less scapular anterior tilt angles in the forward transfer task (6°, P < .001) than males. Age was positively associated with humeral elevation (R2 = .330, P < .001) and scapular rotation (R2 = .299, P < .001) in the Wash Axilla task. There exist some kinematic differences between sex and with advancing age for select functional tasks, which should be considered for musculoskeletal disorder development.

Does calibration pose improve scapular kinematic repeatability in functional tasks?

Tracking scapular motion can be challenging. More research is needed to determine the best practices for scapular measurement in multi-planar tasks. The purpose of this study was to compare the repeatability of scapular kinematics during a functional task protocol calculated from different calibration procedures. It was hypothesized that select poses would improve repeatability in specific tasks. The torso, humerus, and scapula were tracked with optical motion capture in two sessions for ten pain-free participants. Scapular calibrations were completed in five poses: neutral, maximum elevation, 90° abduction, hand to contralateral shoulder, and hand to back. Each participant completed eight functional tasks (Comb Hair, Wash Axilla, Tie Apron, Overhead Reach, Side Reach, Forward Transfer, Floor Lift, Overhead Lift). Scapular angles were calculated with five different calibration procedures and extracted at 30° increments of humeral elevation in each task. Mean difference, limits of agreement, intraclass correlations, and minimal detectable change (MDC) were calculated for each task and elevation level. The inclusion of different calibration poses did not markedly improve outcomes over the maximum elevation double calibration for most tasks. Using this calibration procedure, median MDCs were 10.0° for upward rotation, 13.7° for internal rotation, and 9.8° for tilt.

Monitoring Scapular Kinematics through Wearable Magneto-Inertial Measurement Units: State of the Art and New Frontiers

Monitoring shoulder kinematics, including the scapular segment, is of great relevance in the orthopaedic field. Among wearable systems, magneto-inertial measurement units (M-IMUs) represent a valid alternative for applications in unstructured environments. The aim of this systematic literature review is to report and describe the existing methods to estimate 3D scapular movements through wearable systems integrating M-IMUs. A comprehensive search of PubMed, IEEE Xplore, and Web of Science was performed, and results were included up to May 2023. A total of 14 articles was included. The results showed high heterogeneity among studies regarding calibration procedures, tasks executed, and the population. Two different techniques were described, i.e., with the x-axis aligned with the cranial edge of the scapular spine or positioned on the flat surface of the acromion with the x-axis perpendicular to the scapular spine. Sensor placement affected the scapular motion and, also, the kinematic output. Further studies should be conducted to establish a universal protocol that reduces the variability among studies. Establishing a protocol that can be carried out without difficulty or pain by patients with shoulder musculoskeletal disorders could be of great clinical relevance for patients and clinicians to monitor 3D scapular kinematics in unstructured settings or during common clinical practice.

Defining repeatability for scapulothoracic and thoracohumeral motion during the novel work-related activities and functional task (WRAFT) protocol

Upper limb motion can be challenging to measure and analyze during work or daily life tasks. Further, humeral angle calculation method substantially influences angle outcomes. Therefore, the purpose of this study was to assess the repeatability of scapular and humeral kinematics and compare thoracohumeral angle calculation during a work-related and functional task (WRAFT) protocol. Thirty healthy young adults completed the WRAFT protocol (Comb Hair, Wash Axilla, Tie Apron, Overhead Reach, Side Reach, Forward Transfer, Floor Lift, and Overhead Lift) on two separate occasions. Peak humeral angles and select scapular angles were extracted for each task. Intra-class correlation coefficients (ICCs), standard error of measurement, and minimal detectable change (MDC) were examined. Humeral angles were compared using the XZY and ZXY rotation sequences and "true" axial rotation for incidence of gimbal lock and amplitude coherence. Results showed that for scapular kinematics, elevation-based WRAFTs produced overall better ICC scores (0.23-0.90) compared to those tasks primarily driven by lateral humeral motion (0.02-0.84). MDCs ranged from 7°-78°, suggesting some tasks demonstrated good repeatability (Comb Hair, Overhead Reach, Floor Lift), while others had very high variability (Side Reach, Tie Apron). Amplitude coherence for thoracohumeral angles was best for ZXY for all tasks except the Comb Hair and Tie Apron, for which XZY is recommended. "True" axial rotation demonstrated good coherence for all but Tie Apron. The WRAFT protocol may be used for functionally relevant scapular and humeral kinematic assessment for select task and posture combinations.