A protocol-based treatment plan to improve shoulder function in children with brachial plexus birth injury: a comparative study

Abstract

Children with permanent brachial plexus birth injury have a high risk of developing posterior shoulder subluxation. In 2010, we implemented a protocol to reduce the incidence of this deformity, including early passive exercises, ultrasound screening, botulinum toxin-A injections, shoulder splinting and targeted surgeries. Two-hundred and thirty-seven consecutive children treated at our institution, with a mean follow-up of 11 years (range 1 to 17) were compared in three groups: children born from 1995 to 1999 ( n = 53), 2000–2009 ( n = 109) and 2010–2019 ( n = 75). Posterior shoulder subluxation developed in 48% of all patients but the mean age at detection of shoulder subluxation decreased from 5 years to 4.9 months. Need for shoulder relocation surgery also decreased from 28% to 7%. Mean active shoulder external rotation in adduction improved from 2° to 46°. In conclusion, our established protocol has the potential to reduce the incidence of posterior shoulder subluxation in children with brachial plexus birth injury. Level of evidence: II

Detailed Management of Brachial Plexus Birth Injuries: The Miami Protocol at Nicklaus Children's Hospital

“…Early emphasis is placed on shoulder position. We agree with the findings of the group from Helsinki 1 suggesting that early splinting can prevent the need for later operative intervention. Similar findings have been suggested by the group from British Columbia Children's Hospital in Vancouver (the Sup-ER—supination external rotation splint), 2 as well as Texas Scottish Rite in Dallas.…”

Long-term functional outcome of secondary shoulder surgery in brachial plexus birth palsy patients

“…45 a promising conservative therapy protocol to reduce posterior subluxation and thus the need for surgery has been made by Grahn et al 7 this study showed a reduction of the need for relocation surgery from 28% to 7% by using passive motion exercises, early ultrasound screening, BtX injections in the internal rotators, and splinting. 7 the goal of this review was to evaluate the surgical therapy options for BPBP patients, therefore studies describing the conservative therapy only were excluded. the c5-c6 lesion represents 46% to 62% of all BPBP cases, the c5-c7 lesion represents 28% to 30%, and total plexopathy (c5-c8) represents around 10% to 20%.…”

“…The effectiveness of conservative therapy, including physiotherapy, botulin toxin A (BTX) injections, thermoplastic braces, and kinesiology taping is still debated for preventing contractures, muscle shrinkage, and joint deformities. 45 A promising conservative therapy protocol to reduce posterior subluxation and thus the need for surgery has been made by Grahn et al 7 This study showed a reduction of the need for relocation surgery from 28% to 7% by using passive motion exercises, early ultrasound screening, BTX injections in the internal rotators, and splinting. 7 The goal of this review was to evaluate the surgical therapy options for BPBP patients, therefore studies describing the conservative therapy only were excluded.…”

“…The C5-C6 lesion represents 46% to 62% of all BPBP cases, the C5-C7 lesion represents 28% to 30%, and total plexopathy (C5-C8) represents around 10% to 20%. 7,12,46 Although the prognosis for C5-C6 lesions is favourable, the majority of the secondary operated patients had this type of lesion. 12,47 Three studies performed subgroup analysis to investigate the correlation between plexus lesion type and functional outcome.…”

“…First described by Erb and Duchenne in 1874, 4,5 the upper brachial plexus (C5, C6) is most often affected, presenting with partial paralysis of shoulder external rotation, shoulder abduction, and elbow flexion. 6,7 In approximately 25% to 40% of cases, the lower brachial plexus (C7, C8, and Th1) is also affected. 8,9…”