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Delioğlu K, Uzumcugil A, Öztürk E, Bıyık KS, Ozal C, Gunel MK. Cut-off values of internal rotation in the glenohumeral joint for functional tasks in children with brachial plexus birth injury. J Hand Surg Eur Vol 2023; 48:738-746. [PMID: 36788751 DOI: 10.1177/17531934231154362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
Abstract
The aim of this study was to determine the cut-off values of the range of internal rotation motion in the isolated glenohumeral joint that is required for functional tasks in children with an upper root injury of the brachial plexus. Internal rotation motion was measured using a universal goniometer in 97 participants. The Mallet Hand to Spine and Mallet Hand to Belly tasks were assessed as functional tasks that require internal rotation of the shoulder. For the Hand to Spine task, 41° passive and 30° active internal rotation were necessary to reach the S1 level. For the Hand to Belly task, 42° passive and 29° active internal rotation were required to place the palm on the belly without wrist flexion. Of our participants, 97% could touch the belly with or without wrist flexion, but 28% could not reach S1 in the Hand to Spine task. The results of this study show the necessary amount of internal rotation of the shoulder that should be considered in treatment strategies.Level of evidence: III.
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Affiliation(s)
- Kıvanç Delioğlu
- Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Ankara, Turkey
| | - Akin Uzumcugil
- Faculty of Medicine, Department of Orthopedics and Traumatology, Hacettepe University, Ankara, Turkey
| | - Ebru Öztürk
- Faculty of Medicine, Department of Biostatistics, Hacettepe University, Ankara, Turkey
| | - Kubra Seyhan Bıyık
- Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Ankara, Turkey
| | - Cemil Ozal
- Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Ankara, Turkey
| | - Mintaze Kerem Gunel
- Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Ankara, Turkey
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Giddins G. Discussions About Obstetric Brachial Plexus Injuries. Hand Clin 2022; 38:329-335. [PMID: 35985757 DOI: 10.1016/j.hcl.2022.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Although patients with obstetric brachial plexus injuries (OBPI) have been recognized and treated for greater than 100 years there is much that is not understood or is mis-understood. I address 6 areas for discussion: the cause of OBPI and whether it matters to nerve surgeons; the value of the Narakas grading; whether surgeons should perform primary nerve surgery, especially in patients with incomplete OBPI; the cause and treatment of shoulder tightness; the cause and treatment of elbow contracture; and whether patients with OBPI need surgery in adulthood.
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Affiliation(s)
- Grey Giddins
- The Hand to Elbow Clinic, Bath, United Kingdom; Royal United Hospital, Bath, United Kingdom; University of Bath, Bath, United Kingdom.
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Jönsson K, Roos F, Hultgren T. Structures contributing to the shoulder contracture in brachial plexus birth palsy. An intraoperative biomechanical study. J Hand Surg Eur Vol 2022; 47:237-242. [PMID: 34344211 DOI: 10.1177/17531934211034968] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Internal rotation contracture of the shoulder is a common sequel of the brachial plexus birth palsy. The purpose of this study is to describe the surgical method used in our centre and to measure the effect of sequentially releasing several anatomical structures that have been ascribed as the cause of the contracture. Twenty-four consecutive patients were operated on with an open release. We documented the increase in passive external rotation after each surgical step. We found small gains in passive external rotation when performing coracoidectomy and division of the upper part of the subscapularis tendon; 4° (95% confidence interval [CI] 2°-6° p < 0.01) and 6° (95% CI 4°-8° p < 0.01), respectively. A substantial gain in external rotation occurred when dividing the entire subscapularis tendon, 43° (95% CI 38°-48°, p < 0.01). Our findings indicate that a clinically relevant surgical release of the contracture requires lengthening of the entire subscapularis musculo-tendinous unit.Level of evidence: IV.
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Affiliation(s)
- Krister Jönsson
- Department of Hand Surgery, Karolinska Institutet Department of Clinical Science and Education, Södersjukhuset, Sweden
| | - Fredrik Roos
- Department of Hand Surgery, Karolinska Institutet Department of Clinical Science and Education, Södersjukhuset, Sweden
| | - Tomas Hultgren
- Department of Hand Surgery, Karolinska Institutet Department of Clinical Science and Education, Södersjukhuset, Sweden
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Delioğlu K, Uzumcugil A, Öztürk E, Kerem Gunel M. Relative importance of factors affecting activity and upper extremity function in children with Narakas Group 2 brachial plexus birth palsy. J Hand Surg Eur Vol 2021; 46:239-246. [PMID: 33092449 DOI: 10.1177/1753193420964768] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The aim of the study was to determine the differences in upper limb function and activity/participation levels between preschool children with Narakas Groups 2a and 2b obstetric brachial plexus injury; and to determine the significance level of the factors affecting upper limb functions in these patients. Sixty-seven children, aged 3 to 7, who had not had surgical intervention, were evaluated in terms of joint movements, modified Mallet classification, Raimondi hand classification, brachial plexus outcome measure, paediatric outcome data collection instrument and stereognosis. There were significant functional differences between the groups, in favour of Group 2a. The movements affecting total function of the upper limb were: hand to spine (p < 0.001), global abduction (p < 0.001) and hand to mouth (p < 0.001), in descending order of significance. Passive internal rotation was the most important passive joint movement affecting shoulder function (p < 0.001). The results of this study suggest that more emphasis should be placed on the shoulder internal rotation in treatment strategies.Level of evidence: III.
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Affiliation(s)
- Kıvanç Delioğlu
- Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Ankara, Turkey
| | - Akin Uzumcugil
- Department of Orthopedics and Traumatology, Hacettepe University, Ankara, Turkey
| | - Ebru Öztürk
- Department of Biostatistics, Hacettepe University, Ankara, Turkey
| | - Mintaze Kerem Gunel
- Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Ankara, Turkey
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Conjoint muscle transfer and subscapularis slide in brachial plexus birth palsy: Clinical outcomes in shoulder functions. Med J Armed Forces India 2020; 77:181-186. [PMID: 33867635 DOI: 10.1016/j.mjafi.2020.05.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Accepted: 05/11/2020] [Indexed: 11/20/2022] Open
Abstract
Background Shoulder deformity and inadequate shoulder function in brachial plexus birth palsy (BPBP) occur due to imbalance between the shoulder abductors, external rotators, adductors and internal rotators. This is due to cross innervation of the regenerating axons and subsequent target muscle innervation. These lead to internal rotation deformity along with glenohumeral dysplasia. Conjoint muscle transfer in the form of latissimus dorsi and teres major muscle combined with release and slide of subscapularis muscle improves shoulder functions. This study aims to evaluate the outcomes of shoulder function after a simultaneous conjoint muscle transfer and subscapularis slide in the management of BPBP. Methods 18 children with BPBP, who presented with shoulder deformity and inadequate shoulder functions, underwent conjoint muscle transfer along with subscapularis muscle slide. At 18 months, shoulder functions were assessed preoperatively and postoperatively using Mallet score system and range of motions. Statistical analysis was performed to ascertain if the outcomes were statistically significant. Results Mean age was 4.64 years with a mean preoperative Mallet score of 10.89 ± 1.60 and mean postoperative Mallet score of 16.22 ± 1.86. At 18 months, mean gain in shoulder abduction at 18 months was 57.22 ± 16.11° with external rotation of 26.66 ± 7.67°. All children showed improvement in shoulder functions. There was no correlation between the clinical outcomes and age of the child. Conclusion This procedure was effective in improving shoulder functions in a cohort of patients. The long-term effect of this procedure, however, remains to be evaluated by further follow-up and with similar such studies.
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Mahon J, Malone A, Kiernan D, Meldrum D. Kinematic differences between children with obstetric brachial plexus palsy and healthy controls while performing activities of daily living. Clin Biomech (Bristol, Avon) 2018; 59:143-151. [PMID: 30241094 DOI: 10.1016/j.clinbiomech.2018.09.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2018] [Revised: 08/10/2018] [Accepted: 09/03/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND Residual shoulder dysfunction and deformity impacts on functional performance in children with obstetric brachial plexus palsy. Clinical understanding of upper limb dynamic movement patterns is difficult with observation alone. This case-control study describes the significant kinematic differences between children with obstetric brachial plexus palsy compared to typically developing children while performing tasks of the modified Mallet Scale. METHODS Eleven children with obstetric brachial plexus palsy (mean 10 years, range 7-15 years, Narakas group I-III) and 10 typically developing children (mean 9 years 9 months, range 6-15 years) completed three-dimensional upper limb motion analysis using the acromion method to track dynamic scapular movement. Kinematic data were captured by a 4-CODA cx1 optoelectronic tracking system. Participants performed three trials of the modified Mallet scale tasks. Local coordinate systems, segment and joint rotations were defined as recommended by the International Society of Biomechanics. FINDINGS Joint rotation angles against time of the glenohumeral, thoracohumeral and scapulohumeral joints were calculated. Kinematic findings demonstrated increased internal rotation in all postures, reduced glenohumeral excursion, habitual "trumpet" posture of glenohumeral abduction/elevation and variability in movement strategies. Scapulohumeral rhythm during abduction task was 1.88:1 in typically developing children and 1.04:1 in children with obstetric brachial plexus palsy. INTERPRETATION Children with obstetric brachial plexus palsy demonstrate deficient external rotation in all tasks. Despite increased postural internal rotation, ability to move through internal rotation range is compromised. The glenohumeral joint showed the greatest range deficit, contributing to abnormal scapulohumeral rhythm. Future sub-group analysis of Narakas Classification is recommended.
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Affiliation(s)
- Judy Mahon
- Gait Analysis Laboratory, Central Remedial Clinic, Vernon Ave., Clontarf, Dublin 3, Ireland.
| | - Ailish Malone
- Gait Analysis Laboratory, Central Remedial Clinic, Vernon Ave., Clontarf, Dublin 3, Ireland; Royal College of Surgeons, 123 St Stephen's Green, Dublin 2, Ireland
| | - Damien Kiernan
- Gait Analysis Laboratory, Central Remedial Clinic, Vernon Ave., Clontarf, Dublin 3, Ireland
| | - Dara Meldrum
- Royal College of Surgeons, 123 St Stephen's Green, Dublin 2, Ireland
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Mahon J, Malone A, Kiernan D, Meldrum D. Reliability of 3D upper limb motion analysis in children with obstetric brachial plexus palsy. Physiol Meas 2017; 38:524-538. [PMID: 28140349 DOI: 10.1088/1361-6579/aa5c13] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Kinematics, measured by 3D upper limb motion analysis (3D-ULMA), can potentially increase understanding of movement patterns by quantifying individual joint contributions. Reliability in children with obstetric brachial plexus palsy (OBPP) has not been established. OBJECTIVE This study aimed to determine between session reliability and measurement errors of 3D-ULMA using the acromion method (AM) in children with OBPP. APPROACH Ten participants (mean 10 years, range 7-15 years, Narakas classification I-III) completed 3D-ULMA on two occasions, mean interval of 8.6 d (±2.8 d). Kinematic data were captured by a 4-CODA cx1 optoelectronic tracking system. Participants performed three trials of the modified Mallet scale tasks. Local coordinate systems, segment and joint rotations were defined as recommended by the International Society of Biomechanics. The intraclass correlation coefficient (ICC 2,K) and standard error of measurement (SEM) were calculated for task duration, range and joint angle at point of task achievement (PTA). MAIN RESULTS Results indicated poor reliability for spatiotemporal parameters and range. Moderate to excellent reliability at PTA was observed in 19/60 variables (ICC: 0.77-0.98; SEM: 3.5°-10.4°). The Abduction Task had the highest (ICC: 0.79-0.98; SEM: 3.5°-10.3°) with External Rotation the lowest reliability. Glenohumeral and thoracohumeral elevation had the most consistent reliability. Scapular protraction/retraction had consistently poor reliability (ICC: 0-0.72; SEM: 3.5°-10.2°) with axial rotation also poor (ICC: 0.00-0.91; SEM: 6.3°-32.8°). This study determined inconsistent test-retest reliability of 3D-ULMA, using AM, to track dynamic performance of functional tasks in children with OBPP. It is the first study to outline measurement error in this population. This information permits more reliable interpretation of future studies of kinematic patterns in children with OBPP.
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Affiliation(s)
- Judy Mahon
- Gait Analysis Laboratory, Central Remedial Clinic, Vernon Ave., Clontarf, Dublin 3, Ireland
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Bahm J. The Surgical Strategy to Correct the Rotational Imbalance of the Glenohumeral Joint after Brachial Plexus Birth Injury. J Brachial Plex Peripher Nerve Inj 2017; 11:e10-e17. [PMID: 28077955 DOI: 10.1055/s-0036-1579763] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2014] [Accepted: 01/22/2016] [Indexed: 10/22/2022] Open
Abstract
In upper brachial plexus birth injury, rotational balance of the glenohumeral joint is frequently affected and contracture in medial rotation of the arm develops, due to a severe palsy or insufficient recovery of the lateral rotators. Some of these children present with a severe glenohumeral joint contracture in the first months, although regular physiotherapy has been provided, a condition associated with a posteriorly subdislocated or dislocated humeral head. These conditions should be screened early by a pediatrician or specialized physiotherapist. Both aspects of muscular weakness affecting the lateral rotators and the initial or progressive glenohumeral deformity and/or subdislocation must be identified and treated accordingly, focusing on the reestablishment of joint congruence and strengthening of the lateral rotators to improve rotational balance, thus working against joint dysplasia and loss of motor function of the shoulder in a growing child. Our treatment strategy adapted over the last 20 years to results from retrospective studies, including biomechanical aspects on muscular imbalance and tendon transfers. With this review, we confront our actual concept to recent literature.
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Affiliation(s)
- J Bahm
- Euregio Reconstructive Microsurgery Unit, Franziskushospital, Aachen (D), Germany
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Satbhai NG, Doi K, Hattori Y, Sakamoto S. Contralateral lower trapezius transfer for restoration of shoulder external rotation in traumatic brachial plexus palsy: a preliminary report and literature review. J Hand Surg Eur Vol 2014; 39:861-7. [PMID: 24212416 DOI: 10.1177/1753193413512245] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The importance of external rotation of the shoulder is well accepted. Patients with inadequate recovery of shoulder function after nerve transfers for a brachial plexus injury have difficulty in using their reconstructed limb. The options for secondary procedures to improve shoulder function are often limited, especially if the spinal accessory nerve has been used earlier for nerve transfer or as a donor nerve for a free functioning muscle transfer. We have used the contralateral lower trapezius transfer to the infraspinatus in three cases, to restore shoulder external rotation. All patients had significant improvement in shoulder external rotation (mean 97°; range 80°-110°) and improved disability of the arm, shoulder and hand scores. The rotation occurred mainly at the glenohumeral joint, and was independent of the donor side. All patients were greatly satisfied with the outcome. Contralateral lower trapezius transfer appears to help in overall improvement of shoulder function by stabilizing the scapula. The results have remained stable after mean follow-up of 58 months (range 12-86). No donor site deficit was seen in any patient.
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Affiliation(s)
- N G Satbhai
- Department of Orthopedic Surgery, Ogori Daiichi General Hospital, Yamaguchi, Japan
| | - K Doi
- Department of Orthopedic Surgery, Ogori Daiichi General Hospital, Yamaguchi, Japan
| | - Y Hattori
- Department of Orthopedic Surgery, Ogori Daiichi General Hospital, Yamaguchi, Japan
| | - S Sakamoto
- Department of Orthopedic Surgery, Ogori Daiichi General Hospital, Yamaguchi, Japan
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External Rotation Osteotomy of the Humerus to Salvage the Failed Latissimus Dorsi Transfer in Children With Erb Birth Palsy and Supple Congruent Shoulders. Ann Plast Surg 2014; 75:625-8. [PMID: 25180949 DOI: 10.1097/sap.0000000000000331] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Management of the failed latissimus dorsi muscle transfer to restore shoulder external rotation has received little attention in the literature. We report on 6 children with Erb birth palsy and supple congruent shoulders and who underwent external rotation osteotomy to salvage a failed latissimus dorsi transfer. It is standard of care to do humerus osteotomies only to children with significant deformities of the glenohumeral joint. In the current article, the osteotomy was performed despite the presence of supple congruent shoulders because the osteotomy seemed the best and simplest option available. The functional outcome was satisfactory; with all patients reaching the occiput easily. Furthermore, there were improvement of the standing posture and improvement of the elbow flexion contracture. We conclude that the osteotomy procedure is a simple and effective option of management after a failed latissimus dorsi transfer.
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Aly A, Bahm J, Schuind F. Percutaneous humeral derotational osteotomy in obstetrical brachial plexus palsy: a new technique. J Hand Surg Eur Vol 2014; 39:549-52. [PMID: 23748411 DOI: 10.1177/1753193413492058] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Thirty three per cent of children with obstetrical brachial plexus palsy with incomplete neurological recovery develop shoulder internal contracture associated with osseous deformity. Some of the older children are treated by humeral derotational osteotomy. The classical technique of open approach to the humeral diaphysis and plate fixation imposes a longitudinal scar and carries significant risks (nonunion, nerve palsy); a secondary procedure for plate removal is necessary in a significant proportion of patients. The authors report a new technique of percutaneous humeral osteotomy with osteosynthesis by Hoffmann external fixator. In six cases bone healing was obtained at an average of 45 days, without adverse complication. The postoperative results showed improved shoulder function. This new technique is simple and safe; it represents a new option for the treatment of sequelae of obstetrical brachial plexus palsy.
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Affiliation(s)
- A Aly
- Department of Orthopaedics and Traumatology, Erasme University Hospital, Brussels, Belgium
| | - J Bahm
- Department of Orthopaedics and Traumatology, Erasme University Hospital, Brussels, Belgium
| | - F Schuind
- Department of Orthopaedics and Traumatology, Erasme University Hospital, Brussels, Belgium
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Pearl ML, van de Bunt F, Pearl M, Lightdale-Miric N, Rethlefsen S, Loiselle J. Assessing shoulder motion in children: age limitations to Mallet and ABC Loops. Clin Orthop Relat Res 2014; 472:740-8. [PMID: 24136803 PMCID: PMC3890187 DOI: 10.1007/s11999-013-3324-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2013] [Accepted: 09/30/2013] [Indexed: 01/31/2023]
Abstract
BACKGROUND Shoulder ROM and function of the shoulder are difficult to evaluate in young children. There has been no determination of the age at which children can comply with the current assessment tools in use, but doing so would be important, because it gives us more accurate insight into the development and assessment of shoulder functional ROM in young children. QUESTIONS/PURPOSES We (1) determined whether age would limit the use of two different observational scales used to assess shoulder ROM and function in young children (the Mallet scale and the ABC Loops protocol); and (2) compared the two scales in terms of intra- and interobserver reliabilities. METHODS Sixty-five able-bodied children (32 boys, 33 girls; mean age, 3.9 years; range, 0.5-7.0 years) were recruited from local preschools and evaluated using the Mallet scale and ABC Loops protocol. Children were assessed on their ability to complete the examinations and time to completion for each measurement protocol. Intra- and interobserver reliability was tested by percentage agreement. Forty-eight children (mean age, 4.4 years; SD, 1.3 years) were able to complete the Mallet and ABC Loops measurement protocols; 17 children (mean age, 2.3 years; SD, 1.1 years) failed to complete either test. RESULTS Younger children had more difficulty completing the examinations; there was a strong negative correlation between age and failure: probability of failure increased with decreasing age (Pearson r = -0.601, p < 0.001). Children who were able to complete one test were able to complete the other. Interobserver and intraobserver agreement was very high for both scales (in excess of 95% for all comparisons), and with the numbers available, there were no differences between the scales. CONCLUSIONS The Mallet scale and ABC Loops protocol have high reliability metrics in children younger than 6 years, but very young children (those younger than 3 years) generally will not be able to complete the examinations. The ABC Loops test took longer to perform than the Mallet scale but may more comprehensively evaluate a child's functional capabilities. We therefore state that both assessment tools can be reliably used in children older than 3 years; we believe the ABC Loops gives a more accurate assessment of shoulder ROM.
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Affiliation(s)
- Michael L. Pearl
- />Department of Orthopedic Surgery, Kaiser Permanente Medical Center Los Angeles, Los Angeles, CA USA
| | - Fabian van de Bunt
- />Vrije Universiteit Amsterdam, De Boelelaan 1105, 1081 HV Amsterdam, The Netherlands
| | - Michaela Pearl
- />Department of Orthopedic Surgery, Kaiser Permanente Medical Center Los Angeles, Los Angeles, CA USA
| | - Nina Lightdale-Miric
- />Department of Orthopedic Surgery, Children’s Hospital Los Angeles, Los Angeles, CA USA
| | - Susan Rethlefsen
- />Department of Orthopedic Surgery, Children’s Hospital Los Angeles, Los Angeles, CA USA
| | - Jennifer Loiselle
- />Department of Orthopedic Surgery, Children’s Hospital Los Angeles, Los Angeles, CA USA
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Hultgren T, Jönsson K, Pettersson H, Hammarberg H. Surgical correction of a rotational deformity of the shoulder in patients with obstetric brachial plexus palsy. Bone Joint J 2013; 95-B:1432-8. [DOI: 10.1302/0301-620x.95b10.32049] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
We evaluated results at one year after surgical correction of internal rotation deformities in the shoulders of 270 patients with obstetric brachial plexus palsy. The mean age at surgery was 6.2 years (0.6 to 35). Two techniques were used: open subscapularis elongation and latissimus dorsi to infraspinatus transfer. In addition, open relocation was performed or attempted in all patients with subluxed or dislocated joints. A mixed effects model approach was used to evaluate the effects of surgery on internal and external rotation, abduction, flexion and Mallet score. Independent factors included operative status (pre- or post-operative), gender, age, the condition of the joint, and whether or not transfer was performed. The overall mean improvement in external rotation following surgery was 84.6° (95% confidence interval (CI) 80.2 to 89.1) and the mean Mallet score improved by 4.0 (95% CI 3.7 to 4.2). There was a mean decrease in internal rotation of between 27.6° and 34.4° in the relocated joint groups and 8.6° (95% CI 5.2 to 12.0) in the normal joint group. Abduction and flexion were unchanged following surgery. Adding a latissimus dorsi transfer did not result in greater improvement in the mean external rotation compared with elongation of the subscapularis alone. Cite this article: Bone Joint J 2013;95-B:1432–8.
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Affiliation(s)
- T. Hultgren
- Karolinska Institute, Department
of Clinical Science and Education, Södersjukhuset, Section
for Hand Surgery, S-118 83 Stockholm, Sweden
| | - K. Jönsson
- Karolinska Institute, Department
of Clinical Science and Education, Södersjukhuset, Section
for Hand Surgery, S-118 83 Stockholm, Sweden
| | - H. Pettersson
- Karolinska Institute, Department
of Clinical Science and Education, Södersjukhuset, S-118
83 Stockholm, Sweden
| | - H. Hammarberg
- Karolinska Institute, Department
of Clinical Science and Education, Södersjukhuset, Section
for Hand Surgery, S-118 83 Stockholm, Sweden
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