Permanent Brachial Plexus Birth Injury: Helsinki Shoulder Protocol

Petra Grahn; Tiina Pöyhiä; Yrjänä Nietosvaara

doi:10.1055/s-0043-1768940

Permanent Brachial Plexus Birth Injury: Helsinki Shoulder Protocol

Semin Plast Surg. 2023 Jul 14;37(2):108-116. doi: 10.1055/s-0043-1768940. eCollection 2023 May.

Authors

Petra Grahn¹, Tiina Pöyhiä², Yrjänä Nietosvaara^{1

3}

Affiliations

¹ Department of Pediatric Orthopedics and Traumatology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
² Department of Radiology, HUS Diagnostic Center, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
³ Department of Pediatric Surgery, University of Eastern Finland and Kuopio University Hospital, Kuopio, Finland.

PMID: 37503533
PMCID: PMC10371410 (available on 2024-07-14)
DOI: 10.1055/s-0043-1768940

Abstract

Passive shoulder exercises from birth and ultrasound screening from 3 to 12 months. Botox is given to shoulder internal rotators and a bracing commenced, if alpha-angle exceeds 30°, or passive shoulder external rotation is below 70 degrees. Plexus reconstruction is recommended to children with root avulsion(s) on magnetic resonance imaging or 3-month Toronto Test Score < 3.5. Specific neurotization is recommended to children without avulsions, but lack of progress in healing. Shoulder dysplasia was diagnosed in 49% of 270 patients with permanent brachial plexus birth injury in our catchment area from 1995 to 2021. The age at detection of shoulder dysplasia dropped from mean 5.4 years in children born before 2000 to mean 3.9 months in children born after 2009. Botox was given to 57% of the patients born after 2009. Rate of shoulder relocation decreased from 28 to 7% while mean active shoulder external rotation in adduction increased from 2 to 46°.

Keywords: botox; brachial plexus birth injury; dysplasia; external rotation; glenohumeral joint; infraspinatus; neurotization; screening; shoulder; shoulder contracture; subluxation; ultrasound.

Publication types

Review