Shoulder and elbow kinematics during the Mallet score in obstetrical brachial plexus palsy.
BACKGROUND
The physical signs of obstetrical brachial plexus palsy range from temporary upper-limb dysfunction to a lifelong impairment and deformity in one arm. The aim of this study was to analyze the kinematics of the upper limb and to evaluate the contribution of glenohumeral and scapulothoracic joints of obstetrical brachial plexus palsy children.


METHODS
Six children participated in this study: 2 males and 4 females with a mean age of 11.7years. Three patients had a C5, C6 lesion and 3 had a C5, C6, C7 lesion. They were asked to perform five tasks based on the Mallet scale and the kinematic data were collected using the Fastrak electromagnetic tracking device.


RESULTS
The scapulothoracic protraction and posterior tilt were significantly increased in the involved limb during the hand to mouth task (p=0.006 and p=0.015 respectively). The scapulothoracic Protraction/glenohumeral Elevation ratio was significantly increased in the involved limb during the hand to neck task (p=0.041) and the elevation task (p=0.015). The ratios of scapulothoracic Tilt on the three glenohumeral excursion angles were significantly increased during the hand to mouth task (p≤0.041). The scapulothoracic Mediolateral/glenohumeral Elevation ratio was significantly increased in the involved limb during the elevation task (p=0.038). The glenohumeral elevation excursion was significantly decreased in the involved limb during the hand to neck task (p<0.001) and the elevation task (p=0.0003).


CONCLUSIONS
This study gives us information about the greater contribution of the scapulothoracic joint to shoulder motion for affected arm of obstetrical brachial plexus palsy patients compared to their unaffected arm. Kinematic analysis could be useful in shoulder motion evaluation during the Mallet score and to evaluate outcomes after surgery.
Hôpital Trousseau, Service de chirurgie orthopédique pédiatrique, 26 Avenue du Dr Arnold Netter, 75012 Paris, France. Electronic address: olivierherisson@hotmail.com.
Olivier
O
Herisson
Ecole Nationale Supérieure d'Arts et Métiers - Equipe Biomécanique et Remodelage Osseux, 151 boulevard de l'Hôpital, 75013 Paris, France. Electronic address: nathalie.maurel@ensam.eu.
Nathalie
N
Maurel
Ecole Nationale Supérieure d'Arts et Métiers - Equipe Biomécanique et Remodelage Osseux, 151 boulevard de l'Hôpital, 75013 Paris, France. Electronic address: amadou.diop@ensam.eu.
Amadou
A
Diop
Hôpital Trousseau, Service de chirurgie orthopédique pédiatrique, 26 Avenue du Dr Arnold Netter, 75012 Paris, France. Electronic address: m.lechatelier@gmail.com.
Morgane
M
Le Chatelier
Université Pierre et Marie Curie, 91 Boulevard de l'Hôpital, 75013 Paris, France. Electronic address: adeline_cambon@yahoo.fr.
Adeline
A
Cambon-Binder
Hôpital Trousseau, Service de chirurgie orthopédique pédiatrique, 26 Avenue du Dr Arnold Netter, 75012 Paris, France; Université Pierre et Marie Curie, 91 Boulevard de l'Hôpital, 75013 Paris, France. Electronic address: franck.fitoussi@aphp.fr.
Franck
F
Fitoussi
D001696:Biomechanical Phenomena; D020516:Brachial Plexus Neuropathies / Q000175:diagnosis / Q000503:physiopathology*; D002648:Child; D004551:Elbow Joint / Q000503:physiopathology*; D005260:Female; D006801:Humans; D008297:Male; D010246:Paralysis, Obstetric / Q000175:diagnosis / Q000503:physiopathology*; D012785:Shoulder Joint / Q000503:physiopathology*; D013647:Task Performance and Analysis
Electromagnetic; Glenohumeral joint; Kinematics; Obstetrical brachial plexus palsy; Reliability test; Scapulothoracic joint; Upper limb palsy