Range of motion and strength after surgery for brachial plexus birth palsy

Figures & data

Table 1. Types of secondary procedures performed during the follow-up period

Extent of injury	Median age in years at operation (range)	Median number of procedures (range)	Soft-tissue shoulder procedure	Humeral osteotomy	Soft-tissue forearm procedure	Bone forearm procedure	Hand procedure
C5–6 (n=51)	7 (1–13)	1 (1–3)	15	6	4	0	0
C5–7 (n=31)	5 (2–11)	2 (1–4)	16	3	5	2	5
Total (n=25)	6 (5–11)	2 (1–3)	6	3	11	3	5
Sum			37	12	20	5	10

The Metitur Good Strength device for measurement of elbow flexion strength.

Table 2. Median active range of motion (ROM) of the affected upper limb and the ratio (%) between affected and unaffected limb according to the extent of injury

	C5-6		C5-7		Total
	ROM	Ratio	ROM	Ratio	ROM	Ratio
Shoulder
External rotation in adduction	–8	0	7	11	–15	0
Abduction	125	75	68	36	50	28
Extension	31	43	10	17	11	20
Flexion	126	75	82	50	51	44
Elbow and forearm
Extension deficiency	20	94	25	90	35	44
Flexion	135	94	128	90	128	96
Pronation	80	79	67	58	54	54
Supination	50	71	30	42	0	0
Wrist
Extension	65	86	44	60	35	47
Flexion	65	100	60	92	44	75
Radial deviation	24	100	0	0	–2	0
Ulnar deviation	40	100	41	78	20	44

Table 3. Isometric strength (N) measurements using the Metitur Good Strength device. Grip strength was also measured by the Jamar dynamometer (kg). Max. value of 3 attempts

Median total values
	Affected side	Unaffected side	Ratio
			%	Range
Shoulder external rotation	18	70	28
C5-6	25	66	38	0–100
C5-7	16	72	23	0–81
total	9	74	12	0–105
Shoulder internal rotation	43	103	44
C5-6	53	99	60	18–147
C5-7	36	118	37	9–96
total	42	118	35	0–62
Elbow flexion	59	151	43
C5-6	60	133	51	5–90
C5-7	66	157	42	0–88
total	46	158	36	0–62
Elbow extension	55	114	49
C5-6	69	101	80	5–185
C5-7	44	129	40	4–80
total	34	116	27	0–81
Grip	123	228	68
C5-6	151	207	88	41–121
C5-7	159	241	64	32–91
total	38	226	21	0–86
Grip (Jamar)	8	21	35
C5-6	11	20	61	19–111
C5-7	7	23	30	3–80
total	1	20	6	0–33

Table 4. Odds ratios (ORs) and their 95% confidence intervals (CIs) for shoulder rotation strength (Good Strength; Metitur). Age at plexus surgery, sex, type of injury, and congruency of glenohumeral joint were considered as independent covariates in logistic regression models. A strength ratio of > 0.89 between the affected and the unaffected side was considered normal

		Shoulder external rotation			Shoulder internal rotation
		(ratio>0.89)			(ratio >0.89)
Characteristic	n	OR	95% CI	p-value	OR	95% CI	p-value
Age (months)
< 3	67	1			1
> 3	40	1.8	0.66–4.8	0.3	2.2	0.89–5.40	0.09
Sex
F	65	1			1
M	42	1.1	0.41–2.9	0.9	1.8	0.79–4.3	0.2
Type of injury
no avulsion	69	1			1
avulsion	38	0.4	0.13–1.2	0.09	0.4	0.14–0.89	0.03
Congruency of glenohumeral joint
yes	80	1			1
no	15	1.3	0.36–4.7	0.7	2.2	0.69–6.7	0.2

Table 5. Odds ratios (ORs) and their 95% confidence intervals (CIs) for isometric elbow and hand strength measured by the Good Strength and Jamar dynamometers. Age at plexus surgery, sex, type of injury, and congruency of radiohumeral joint were considered as independent covariates in the logistic regression models. A strength ratio of > 0.89 between the affected and the unaffected side was considered normal

		Grip strength (Jamar)			Grip strength (GS)			Elbow flexion (GS)			Elbow extension (GS)
		(> 0.89)			(> 0.89)			(> 0.89)			(> 0.89)
Characteristic	n	OR	95% CI	p-value	OR	95% CI	p-value	OR	95% CI	p-value	OR	95% CI	p-value
Age (months)
< 3	67	1			1			1			1
> 3	40	1.2	0.48–3.0	0.7	0.5	0.56–4.7	0.3	0.6	0.25–1.6	0.3	0.8	0.34–2.02	0.7
Sex
F	65	1			1			1			1
M	42	1	0.70–2.4	0.9	1	0.93–8.0	0.07	0.6	0.26–1.5	0.3	1.9	0.81–4.5	0.1
Type of injury
no avulsion	69	1			1			1			1
avulsion	38	0.3	0.11–0.76	0.01	0.4	0.16–1.04	0.06	0.3	0.12–0.79	0.01	0.5	0.23–1.3	0.2
Congruency of radiohumeral joint
yes	89	1			1			1			1
no	18	0.2	0.035–0.79	0.02	0.2	0.073–0.70	0.01	0.4	0.14–1.7	0.3	0.3	0.093–0.95	0.04