title: Prevalence of Posterior Shoulder Subluxation in Children With Neonatal Brachial Plexus Palsy After Early Full Passive Range of Motion Exercises.
abstract: BACKGROUND
  Children with neonatal brachial plexus palsy (NBPP) are often prescribed shoulder range of motion (ROM) exercises; however, the extent and timing of exercise implementation remains controversial in the context of shoulder joint integrity. The association of ROM exercises to delayed posterior shoulder subluxation (PSS) is unknown.
  
  
  OBJECTIVE
  To determine prevalence of PSS in children with NBPP who began full passive ROM exercises before 6 months of age, and characteristics associated with development or absence of PSS in children.
  
  
  METHODS
  Cross-sectional study.
  
  
  METHODS
  Tertiary care NBPP referral center.
  
  
  METHODS
  Forty-six children with NBPP, aged 24-57 months, who began full ROM exercises before 6 months of age.
  
  
  METHODS
  One radiologist conducted bilateral shoulder ultrasound (US) on each child to evaluate for PSS. One occupational therapist evaluated each child clinically for PSS using defined parameters without knowledge of US results.
  
  
  METHODS
  By US, 20% of children had PSS; 46% had PSS by clinical examination. Shoulder active ROM limitations and history of shoulder surgery were associated with presence of PSS. Extent of NBPP was not associated with PSS.
  
  
  RESULTS
  Nine of 46 children (20%) met US criteria for PSS; α angle was 58° ± 21° (mean ± standard deviation [SD]). Twenty-one children (46%) met clinical criteria. Mean age at examination was 35 ± 10 months. Shoulder active ROM (P ≤ .004) was associated with PSS, whereas passive ROM was not (P ≥ .08). History of secondary shoulder surgery and primary nerve graft repair were associated with PSS (P = .04). Extent of NBPP by Narakas classification was not associated with PSS (P = .48).
  
  
  CONCLUSIONS
  Early use of full-arc passive ROM home exercise program is not associated with increased prevalence of PSS in children with NBPP compared to prevalence of PSS in published literature. We suggest careful clinical examination, based on defined criteria, provides a reasonable screening examination for evaluating PSS that can be confirmed by noninvasive US.
authors.affiliation: Department of Neurosurgery, University of Michigan, Ann Arbor, MI.
authors.forename: Denise
authors.initials: D
authors.lastname: Justice
authors.affiliation: Department of Neurosurgery, University of Michigan, Ann Arbor, MI.
authors.forename: Lynnette
authors.initials: L
authors.lastname: Rasmussen
authors.affiliation: Department of Radiology, University of Michigan, Ann Arbor, MI.
authors.forename: Michael
authors.initials: M
authors.lastname: Di Pietro
authors.affiliation: Department of Neurosurgery, University of Michigan, Ann Arbor, MI.
authors.forename: Kate W-C
authors.initials: KW
authors.lastname: Chang
authors.affiliation: Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI.
authors.forename: Susan L
authors.initials: SL
authors.lastname: Murphy
authors.affiliation: Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI.
authors.forename: Virginia S
authors.initials: VS
authors.lastname: Nelson
authors.affiliation: Department of Neurosurgery, University of Michigan, 1500 E. Medical Center Dr., Rm 3552 TC, Ann Arbor, MI 48109-5338.
authors.forename: Lynda J-S
authors.initials: LJ
authors.lastname: Yang
mesh_terms: D001917:Brachial Plexus; D020516:Brachial Plexus Neuropathies / Q000453:epidemiology* / Q000209:etiology / Q000534:rehabilitation; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D005081:Exercise Therapy / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D010243:Paralysis / Q000150:complications* / Q000503:physiopathology / Q000534:rehabilitation; D015995:Prevalence; D016059:Range of Motion, Articular / Q000502:physiology*; D012189:Retrospective Studies; D012785:Shoulder Joint / Q000000981:diagnostic imaging / Q000503:physiopathology*; D014463:Ultrasonography; D014481:United States / Q000453:epidemiology