title: Degree of Contracture Related to Residual Muscle Shoulder Strength in Children with Obstetric Brachial Plexus Lesions.
abstract: OBJECTIVE
  Little is known about the relation between residual muscle strength and joint contracture formation in neuromuscular disorders. This study aimed to investigate the relation between residual muscle strength and shoulder joint contractures in children with sequelae of obstetric brachial plexus lesion (OBPL). In OBPL a shoulder joint contracture is a frequent finding. We hypothesize that residual internal and external rotator strength and their balance are related to the extent of shoulder joint contracture.
  
  
  METHODS
  Clinical assessment was performed in 34 children (mean 10.0 years) with unilateral OBPL and Narakas classes I-III. External and internal rotation strengths were measured with the shoulder in neutral position using a handheld dynamometer. Strength on the affected side was given as percentage of the normal side. Contracture was assessed by passive internal and external rotations in degrees (in 0° abduction). Mallet classification was used for active shoulder function.
  
  
  RESULTS
  External and internal rotation strengths on the affected side were approximately 50% of the normal side and on average both equally affected: 56% (SD 18%) respectively 51% (SD 27%);r= 0.600,p= 0.000. Residual strengths were not related to passive internal or external rotation (p> 0.200). Internal rotation strength (r=  - 0.425,p<0.05) was related to Narakas class. Mallet score was related to external and internal rotation strengths (r= 0.451 andr= 0.515, respectively;p< 0.01).
  
  
  CONCLUSIONS
  The intuitive notion that imbalances in residual muscle strength influence contracture formation cannot be confirmed in this study. Our results are of interest for the understanding of contracture formation in OBPL.
authors.affiliation: Department of Orthopaedic Surgery, VU Medical Center, Amsterdam, The Netherlands.
authors.forename: Valerie M
authors.initials: VM
authors.lastname: van Gelein Vitringa
authors.affiliation: Department of Orthopaedic Surgery, Spaarne Ziekenhuis, Hoofddorp, The Netherlands.
authors.forename: Arthur
authors.initials: A
authors.lastname: van Noort
authors.affiliation: Department of Plastic Surgery, VU Medical Center, Amsterdam, The Netherlands.
authors.forename: Marco J P F
authors.initials: MJ
authors.lastname: Ritt
authors.affiliation: Department of Orthopaedic Surgery, VU Medical Center, Amsterdam, The Netherlands.
authors.forename: Barend J
authors.initials: BJ
authors.lastname: van Royen
authors.affiliation: Department of Orthopaedic Surgery, VU Medical Center, Amsterdam, The Netherlands.
authors.forename: Johannes A
authors.initials: JA
authors.lastname: van der Sluijs
keywords: contracture; muscle force/strength; obstetric brachial plexus lesion; shoulder function