title: Evaluation of shoulder function after secondary surgery in children with Neonatal Brachial Plexus Palsy.
abstract: OBJECTIVE
  Shoulder function in children with Neonatal Brachial Plexus Palsy (NBPP) can be impaired. Functional gain is possible by an internal contracture release and muscle tendon transfer (ICL+MTT) for external rotation. This study evaluates the functional results of this intervention.
  
  
  METHODS
  Assessments were done pre-operatively and 3, 6 and 12 months thereafter and included joint-mobility (ROM), muscle strength, arm function (Assisting Hand Assessment (AHA) and Mallet-score), Quality of Life (QoL) (Pediatric Outcome Data Collecting Instrument (PODCI)) and parental satisfaction. Changes were examined using Wilcoxon's Signed-Rank test and Cohen's effect size.
  
  
  RESULTS
  Ten children (5 boys) aged 3-10 years who underwent a combined ICL+MTT (mm. Latissimus Dorsi/Teres Major) were included.Active and passive external rotation ROM and muscle strength improved (p < 0.05). Arm function improved according to the Mallet-score (Hand-to-Head, Hand-to-Mouth, External-Rotation) (p < 0.05) and the arm use and pace scales of the AHA (p < 0.05). The PODCI Upper Extremity/Physical Functioning and Global Functioning subscales also showed improvements (p < 0.05). Parents were highly satisfied concerning daily life activities and sports.
  
  
  CONCLUSIONS
  ICL+MTT leads to improvement of ROM, strength, arm function, QoL and high parental satisfaction in this studies' patients and is therefore a good intervention to consider in children with NBPP with limited shoulder function.
authors.affiliation: Department of Orthopaedics and Rehabilitation, Leiden University Medical Center, Leiden, The Netherlands.|Rijnlands Rehabilitation Center, Leiden, The Netherlands.
authors.forename: Menno
authors.initials: M
authors.lastname: van der Holst
authors.affiliation: Department of Orthopaedics and Rehabilitation, Leiden University Medical Center, Leiden, The Netherlands.|Rijnlands Rehabilitation Center, Leiden, The Netherlands.
authors.forename: Thea P M Vliet
authors.initials: TP
authors.lastname: Vlieland
authors.affiliation: Department of Orthopaedics and Rehabilitation, Leiden University Medical Center, Leiden, The Netherlands.
authors.forename: Jorit J L
authors.initials: JJ
authors.lastname: Meesters
authors.affiliation: Department of Orthopaedics and Rehabilitation, Leiden University Medical Center, Leiden, The Netherlands.
authors.forename: W Peter
authors.initials: WP
authors.lastname: Bekkering
authors.affiliation: Department of Orthopaedics and Rehabilitation, Leiden University Medical Center, Leiden, The Netherlands.
authors.forename: Jochem
authors.initials: J
authors.lastname: Nagels
authors.affiliation: Department of Orthopaedics and Rehabilitation, Leiden University Medical Center, Leiden, The Netherlands.
authors.forename: Rob G H H
authors.initials: RG
authors.lastname: Nelissen
mesh_terms: D001720:Birth Injuries / Q000150:complications*; D020516:Brachial Plexus Neuropathies / Q000150:complications*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D008297:Male; D018482:Muscle, Skeletal / Q000601:surgery*; D017060:Patient Satisfaction; D011788:Quality of Life; D016059:Range of Motion, Articular / Q000502:physiology*; D020127:Recovery of Function / Q000502:physiology; D012785:Shoulder Joint / Q000601:surgery*; D011795:Surveys and Questionnaires; D013709:Tendon Transfer / Q000379:methods*; D016896:Treatment Outcome
keywords: Brachial plexus neuropathy; joint capsule release; pediatrics; physical therapy; rehabilitation; tendon transfer; treatment outcome