title: Range of motion and strength after surgery for brachial plexus birth palsy.
abstract: BACKGROUND
  There is little information about the range of motion (ROM) and strength of the affected upper limbs of patients with permanent brachial plexus birth palsy.
  
  
  METHODS
  107 patients who had brachial plexus surgery in Finland between 1971 and 1998 were investigated in this population-based, cross-sectional, 12-year follow-up study. During the follow-up, 59 patients underwent secondary procedures. ROM and isometric strength of the shoulders, elbows, wrists, and thumbs were measured. Ratios for ROM and strength between the affected and unaffected sides were calculated.
  
  
  RESULTS
  61 patients (57%) had no active shoulder external rotation (median 0° (-75-90)). Median active abduction was 90° (1-170). Shoulder external rotation strength of the affected side was diminished (median ratio 28% (0-83)). Active elbow extension deficiency was recorded in 82 patients (median 25° (5-80)). Elbow flexion strength of the affected side was uniformly impaired (median ratio 43% (0-79)). Median active extension of the wrist was 55° (-70-90). The median ratio of grip strength for the affected side vs. the unaffected side was 68% (0-121). Patients with total injury had poorer ROM and strength than those with C5-6 injury. Incongruity of the radiohumeral joint and avulsion were associated with poor strength values.
  
  
  CONCLUSIONS
  ROM and strength of affected upper limbs of patients with surgically treated brachial plexus birth palsy were reduced. Patients with avulsion injuries and/or consequent joint deformities fared worst.
authors.affiliation: Department of Orthopedsics and Traumatology, Hospital for Children and Adolescents, Helsinki University Central Hospital, Finland. mikko.kirjavainen@hus.fi
authors.forename: Mikko O
authors.initials: MO
authors.lastname: Kirjavainen
authors.forename: Yrjänä
authors.initials: Y
authors.lastname: Nietosvaara
authors.forename: Sanna M
authors.initials: SM
authors.lastname: Rautakorpi
authors.forename: Ville M
authors.initials: VM
authors.lastname: Remes
authors.forename: Tiina H
authors.initials: TH
authors.lastname: Pöyhiä
authors.forename: Ilkka J
authors.initials: IJ
authors.lastname: Helenius
authors.forename: Jari I
authors.initials: JI
authors.lastname: Peltonen
mesh_terms: D020516:Brachial Plexus Neuropathies / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D004551:Elbow Joint / Q000503:physiopathology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D007537:Isometric Contraction; D008297:Male; D053580:Muscle Strength / Q000502:physiology; D010246:Paralysis, Obstetric / Q000601:surgery*; D016059:Range of Motion, Articular; D012086:Reoperation; D012785:Shoulder Joint / Q000503:physiopathology; D016896:Treatment Outcome; D014955:Wrist Joint / Q000503:physiopathology