Obstetric brachial plexus palsy: the mallet grading system for shoulder function--revisited

Area of Science:

• Pediatric Orthopedics
• Neurology
• Rehabilitation Medicine

Background:

• The Mallet grading system is standard for assessing shoulder function in pediatric obstetric brachial plexus palsy (OBPP).
• It correlates functional grades with specific degrees of shoulder abduction and external rotation deficits.
• Discrepancies between these two movements can limit the score's applicability.

Purpose of the Study:

• To determine the frequency of cases where the Mallet score is unusable due to conflicting shoulder abduction and external rotation deficits.
• To evaluate the reliability of the Mallet system in older children with Erb's palsy.

Main Methods:

• A cohort of 50 unoperated children over 5 years old with Erb's palsy and shoulder movement deficits was studied.
• The Mallet grading system was applied to assess shoulder abduction and external rotation.
• Cases where the score could not be applied due to movement discrepancies were identified.

Main Results:

• The Mallet score was applicable in 80% (40/50) of the children studied.
• In 20% (10/50) of cases, the Mallet score could not be applied.
• Discrepancies occurred in 7 cases (abduction better than rotation) and 3 cases (rotation better than abduction).

Conclusions:

• The Mallet grading system has limitations in cases with incongruent shoulder abduction and external rotation deficits.
• Separate documentation of shoulder abduction and external rotation deficits is advisable.
• Alternative or supplementary grading systems may offer more comprehensive assessment.