title: Outcome in adolescence of brachial plexus birth palsy. 69 individuals re-examined after 10–20 years.
abstract: OBJECTIVE
  The frequency and severity of a permanent lesion after brachial plexus birth palsy (BPBP) and its impact on activities of daily living are not well documented. We therefore investigated the outcome of BPBP in adolescents, regarding arm function and consequences for activity and participation.
  
  
  METHODS
  Of 30,574 babies born at St. Olavs University Hospital in 1991-2000, 91 had BPBP (prevalence 3 per 1,000), and 69 of these individuals were examined at a median age of 14 (10-20) years. The examination included the modified Mallet classification, range of motion, shoulder rotation and grip strength, Assisting Hand Assessment, and Canadian Occupational Performance Measure. Of the 22 subjects who were not examined, 3 could not be traced and 19 reported having no problems in the affected arm.
  
  
  RESULTS
  At follow-up, 17 adolescents had a permanent lesion (i.e. individual Mallet subscore below 4) with a median Mallet total score of 15 (9-19), while 52 had good or normal shoulder function (median Mallet total score 25 (23-25)). All participants with a permanent lesion had reduced active shoulder rotation (≤15°), 16 had elbow extension deficit, and 10 had subnormal grip strength. External rotation was considerably weaker in the affected shoulder. In addition, they had ineffective use of the affected arm in bimanual activities. Even so, all except 1 were independent in activities of daily living, although 15 experienced minor difficulties.
  
  
  CONCLUSIONS
  Every fourth to fifth child with BPBP had a permanent lesion as an adolescent. External rotation was the most impaired movement. Despite ineffective use of the affected arm in bimanual activities, all of the participants except one were independent in activities of daily living.
authors.affiliation: Departments of Orthopedic Surgery.
authors.forename: Gunn
authors.initials: G
authors.lastname: Hulleberg
authors.forename: Ann-Kristin G
authors.initials: AK
authors.lastname: Elvrum
authors.forename: Merethe
authors.initials: M
authors.lastname: Brandal
authors.forename: Torstein
authors.initials: T
authors.lastname: Vik
mesh_terms: D000203:Activities of Daily Living; D000293:Adolescent; D001720:Birth Injuries / Q000503:physiopathology*; D001917:Brachial Plexus / Q000293:injuries* / Q000503:physiopathology*; D020516:Brachial Plexus Neuropathies / Q000209:etiology* / Q000503:physiopathology*; D002648:Child; D004551:Elbow Joint / Q000502:physiology; D005260:Female; D005500:Follow-Up Studies; D018737:Hand Strength / Q000502:physiology; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D009043:Motor Activity / Q000502:physiology; D010243:Paralysis / Q000209:etiology / Q000503:physiopathology; D016059:Range of Motion, Articular / Q000502:physiology; D012785:Shoulder Joint / Q000502:physiology; D055815:Young Adult