[Upper limb function in children with obstetric brachial plexus palsy].

BACKGROUND

The purpose of the study was to analyze shoulder, elbow and forearm function in children with persistent obstetric brachial plexus palsy. We aimed also to evaluate relationship between age, severity of root involvement and functional deficit of affected limb.

MATERIALS AND METHODS

Fifty-one patients with the Mallet score less than 23 points were entered into a prospective study. Their average age was 6 years and 6 months (range from 18 months to 19 years). There were 30 boys and 21 girls. Clinical data from last follow-up was evaluated.

RESULTS

Average Mallet score was 17 points at last follow-up. The most common problem found in 60% of children was limitation of active external rotation of the shoulder. One forth of patients had posterior dislocation or subluxation in glenohumeraljoint. Moreover, 35.3% had significant limitation of active flexion, 37.3% had limitation of active abduction and 37.3% had limitation of internal rotation of shoulder. Limitation of active forearm pronation was found in 37% and active supination in 50% of patients. Persistent limb dysfunction (except shoulder external rotation) was dependent on root involvement but did not depend on patient's age.

CONCLUSIONS

Limitation of shoulder external rotation with concomitant posterior subluxation or dislocation of the glenohumeral joint is the most common finding in patients with obstetric brachial plexus palsy and does not depend on severity of root involvement, as is related to suprascapular nerve injury. The other shoulder movement are more effected in children with more severe nerve root involvement. Half of our patients had had limitation of forearm supination, what may be related to more common use of pronation in everyday activities.