Scapulothoracic and glenohumeral contributions to motion in children with brachial plexus birth palsy

Stephanie A Russo; Scott H Kozin; Dan A Zlotolow; Kristen F Thomas; Robert L Hulbert; Jeffrey M Mattson; K Michael Rowley; James G Richards

doi:10.1016/j.jse.2013.06.023

Scapulothoracic and glenohumeral contributions to motion in children with brachial plexus birth palsy

J Shoulder Elbow Surg. 2014 Mar;23(3):327-38. doi: 10.1016/j.jse.2013.06.023. Epub 2013 Sep 24.

Authors

Stephanie A Russo¹, Scott H Kozin², Dan A Zlotolow², Kristen F Thomas³, Robert L Hulbert⁴, Jeffrey M Mattson⁴, K Michael Rowley⁴, James G Richards⁴

Affiliations

¹ Biomechanics and Movement Science Program, University of Delaware, Newark, DE, USA. Electronic address: sarusso@udel.edu.
² Upper Extremity Center of Excellence, Shriners Hospital for Children, Philadelphia, PA, USA; Department of Orthopaedic Surgery, Temple University, Philadelphia, PA, USA.
³ Biomechanics and Movement Science Program, University of Delaware, Newark, DE, USA.
⁴ Department of Kinesiology and Applied Physiology, University of Delaware, Newark, DE, USA.

PMID: 24075782
DOI: 10.1016/j.jse.2013.06.023

Abstract

Background: Brachial plexus birth palsy occurs in 0.4 to 4.6 of every 1000 live births, with residual shoulder dysfunction in approximately one third of cases. Clinical measures, such as the Mallet classification, provide no insight into the scapulothoracic and glenohumeral contributions to tested global shoulder movements. This study describes the scapulothoracic and glenohumeral components of shoulder motion during the modified Mallet test.

Methods: Twelve children with Erb's palsy (C5-6) and 8 children with extended Erb's palsy (C5-7) were recruited. The unaffected limbs of 6 subjects were also tested. Locations of markers placed on the thorax, humerus, and scapula were recorded in a neutral position and each of the modified Mallet positions. Scapulothoracic, glenohumeral, and humerothoracic helical displacements and acromion process linear displacements were compared between groups.

Results: The brachial plexus birth palsy groups exhibited significantly smaller glenohumeral displacements in all modified Mallet positions and significantly larger scapulothoracic displacements in the global external rotation and hand to mouth positions. Discriminant function analysis using only humerothoracic variables correctly classified 76.9% of subjects. Discriminant function analysis incorporating scapulothoracic, glenohumeral, and acromion process displacement variables produced accuracy of 92.6%.

Conclusions: Children with brachial plexus birth palsy demonstrated decreased glenohumeral contributions to achieve every modified Mallet position and increased scapulothoracic contribution in two positions compared with the unaffected group. Different scapulothoracic and glenohumeral strategies were identified between groups. Finally, scapulothoracic and glenohumeral components of shoulder motion are more specific than humerothoracic measures to diagnostic classification.

Keywords: Erb’s palsy; Scapulothoracic glenohumeral motion; brachial plexus palsy.

MeSH terms

Acromion / physiopathology
Analysis of Variance
Biomechanical Phenomena
Brachial Plexus Neuropathies / congenital*
Brachial Plexus Neuropathies / physiopathology*
Brachial Plexus Neuropathies / surgery
Child
Discriminant Analysis
Female
Humans
Humerus / physiopathology
Male
Posture
Range of Motion, Articular
Scapula / physiopathology
Shoulder Joint / physiopathology*
Shoulder Joint / surgery
Treatment Outcome