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Hand function in children with an upper brachial plexus birth injury: results of the nine-hole peg test
Igor Immerman1, Daniel T Alfonso, Lorna E Ramos
1Department of Orthopedic Surgery, NYU Hospital for Joint Diseases, New York, NY, USA.
Insights
Children with Erb upper brachial plexus palsy often have subtle hand function deficits. Early therapy should focus on these limitations, even when shoulder function appears good.
Area of Science:
- Pediatric Orthopedics
- Neurology
- Rehabilitation Medicine
Background:
- Erb upper brachial plexus palsy results from upper (C5/C6) nerve root injury.
- While shoulder function is often addressed, hand function deficits may be overlooked.
Purpose of the Study:
- To evaluate hand function in children diagnosed with Erb upper brachial plexus palsy.
- To compare hand function with normative data and shoulder outcomes.
Main Methods:
- Twenty-five children with upper brachial plexus birth injury were assessed.
- Hand function was measured using the nine-hole peg test and compared to the unaffected hand.
- Results were correlated with shoulder outcome scores (Gilbert and Miami).
Main Results:
- Despite good to excellent shoulder function in most children, 80% showed significantly altered hand function.
- The involved hand took 18.8% longer to complete the nine-hole peg test compared to expected norms.
- This difference was statistically significant (p=0.008).
Conclusions:
- Hand function is demonstrably impaired in children with upper brachial plexus birth injury.
- Subtle hand function limitations require recognition and targeted therapy from the outset.
- Focusing on hand function is crucial for comprehensive rehabilitation in this population.
Aim:
The aim of this study was to evaluate hand function in children with Erb upper brachial plexus palsy.
Method:
Hand function was evaluated in 25 children (eight males; 17 females) with a diagnosed upper (C5/C6) brachial plexus birth injury. Of these children, 22 had undergone primary nerve reconstruction and 13 of the 25 had undergone simultaneous and/or secondary shoulder procedures. Hand function was evaluated using the nine-hole peg test at a mean age of 9 years (SD 2y 2mo), and compared with the contralateral, uninvolved hand. Results were compared with age- and sex-matched population norms, and correlated with shoulder outcomes using the Gilbert and Miami scores.
Results:
Although shoulder function was graded as good or excellent in 24 of 25 children, hand function as measured by the nine-hole peg test was significantly altered in the involved hand in 80% (p=0.008). On average the participants took 18.8% longer to complete the task with the involved hand; this was significantly different from the expected difference of 7.2% (p=0.008).
Interpretation:
Hand function is impaired in individuals with upper brachial plexus birth injury. These results suggest that from the initiation of treatment in this population, attention should be paid to recognizing and focusing therapy on subtle limitations of hand function.
