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Elbow flexion contractures in brachial plexus birth injury: function and appearance related factors
Emily S Ho1,2, Karen Klar1, Erin Klar3
1Division of Plastic and Reconstructive Surgery, The Hospital for Sick Children , Toronto , ON , Canada.
Insights
Children with brachial plexus birth injury treated for elbow flexion contracture were older and had more severe contractures. Perceived limb appearance, alongside function, is crucial for managing these contractures.
Area of Science:
- Pediatric Rehabilitation
- Orthopedic Surgery
- Neurology
Background:
- Elbow flexion contractures are common in children with brachial plexus birth injury.
- Management often focuses on functional outcomes, but aesthetic factors may also be important.
Purpose of the Study:
- To identify functional and aesthetic factors influencing elbow flexion contractures in pediatric brachial plexus birth injury patients.
- To understand characteristics of children seeking treatment for elbow flexion contractures.
Main Methods:
- Retrospective cross-sectional study of 200 children (7-18 years) with brachial plexus birth injury.
- Comparison of children who received treatment (surgery, casting/splinting) versus those who did not.
- Analysis of contracture severity, range of motion, and Brachial Plexus Outcome Measure scores.
Main Results:
- Fifty children received treatment, averaging 12.4 years old.
- Treated children had more severe contractures, higher activity scores, and lower self-evaluated appearance scores.
- Pre-treatment passive elbow extension averaged -40.6°.
Conclusions:
- Contracture severity, functional ability, and perceived limb appearance are key factors in managing elbow flexion contractures.
- Routine assessment of perceived appearance is recommended alongside functional evaluation in rehabilitation.
- Considering aesthetic concerns can improve management strategies for these pediatric patients.
Abstract:
Purpose: The purpose of this study was to identify the functional and aesthetic factors associated with an elbow flexion contracture in children with a brachial plexus birth injury who identified their elbow flexion contracture as a problem. Materials and methods: A retrospective cross-sectional study of children with brachial plexus birth injury between 7 and 18 years was conducted to compare the characteristics of children who had treatment for an elbow flexion contracture with those who did not. Results: Fifty of the 200 children included in the study had treatment (one surgical release, 49 serial casting/splinting) for the elbow flexion contracture. Children who had treatment were an average 12.4 years of age, which was significantly older than those who did not have treatment. Elbow extension passive range of motion was an average -40.6° prior to treatment. Stepwise logistical regression model indicated that children who had treatment had greater severity in elbow contracture, higher Brachial Plexus Outcome Measure Activity scores, and lower Brachial Plexus Outcome Measure Self-Evaluation Appearance scores. Conclusions: In addition to severity of contracture and function, perceived appearance of the limb is important factor to evaluate in the management of elbow flexion contractures. Implications for rehabilitation Priority is often given to evaluate the functional implications of elbow flexion contractures in brachial plexus birth injury to determine recommendations for rehabilitation interventions such as serial casting and splinting. Findings in this study indicate that severity of contracture, upper extremity activity function, and perceived upper extremity appearance are important factors in the management of elbow contractures. In addition to upper extremity function, routine evaluation of perceived upper extremity appearance in children and adolescents is important in the management of elbow flexion contractures.
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