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Scapular Stabilization Limits Glenohumeral Stretching in Children With Brachial Plexus Injuries
Stephanie A Russo1, Carolyn M Killelea2, Dan A Zlotolow3
1Department of Orthopaedic Surgery, University of Pittsburgh Medical Center-Hamot, Erie, PA.
Insights
Scapular stabilization may hinder passive stretching for children with brachial plexus birth palsy, particularly those aged 5 and older. Current practice now recommends stretches without stabilization for this group.
Area of Science:
- Pediatric Rehabilitation
- Orthopedic Biomechanics
- Neuromuscular Disorders
Background:
- Brachial plexus birth palsy (BPBP) affects nerve function, potentially leading to joint contractures.
- Scapular stabilization is a common technique used during therapeutic stretching for children with BPBP.
- The precise effect of scapular stabilization on joint kinematics during stretching in this population is not well-defined.
Purpose of the Study:
- To quantitatively assess the impact of scapular stabilization on scapulothoracic and glenohumeral (GH) joint motion during passive stretching in children with BPBP.
- To compare the effects of stabilization performed by a therapist versus a caretaker.
- To explore the correlation between patient age and the effectiveness of stabilization techniques.
Main Methods:
- Utilized 3D motion capture technology to analyze joint angular displacements during external rotation and abduction.
- Collected data from 26 children diagnosed with BPBP, with stretches performed by a therapist and a caretaker.
- Compared kinematic data under three conditions: no stabilization, therapist-assisted stabilization, and caretaker-assisted stabilization.
Main Results:
- During external rotation, no significant differences in joint motion were observed with or without stabilization.
- During abduction, both scapulothoracic and GH joint angular displacements were significantly altered by stabilization.
- Scapular upward rotation and GH elevation were significantly reduced with scapular stabilization, indicating a potentially limited stretch.
Conclusions:
- Scapular stabilization may restrict the range of motion during passive GH joint stretching in children with BPBP, potentially being detrimental.
- Clinical practice has been updated to recommend passive stretching without scapular stabilization for children with BPBP aged 5 years and older.
- For children under 5 years, stretching with and without stabilization is advised pending further objective assessment.
Purpose:
To quantify the effects of scapular stabilization on scapulothoracic and glenohumeral (GH) stretching.
Methods:
Motion capture data during external rotation and abduction with and without scapular stabilization were collected and analyzed for 26 children with brachial plexus birth palsy. These positions were performed by an experienced occupational therapist and by the child's caretaker. Scapulothoracic and GH joint angular displacements were compared between stretches with no stabilization, stabilization performed by the therapist, and stabilization performed by the caretaker. The relationship between the age and ability of the therapist and caretaker to perform the stretches with scapular stabilization was also assessed.
Results:
During external rotation there were no significant differences in either the scapulothoracic or GH joint during stabilization by either the therapist or the caretaker. During abduction, both scapulothoracic and GH joint angular displacements were statistically different. Scapulothoracic upward rotation angular displacement significantly decreased with scapular stabilization by the therapist and caretaker. Glenohumeral elevation angular displacement significantly decreased with scapular stabilization performed by the therapist and caretaker. There were only weak correlations between age and the differences in scapulothoracic and GH joint angular displacement performed by both the therapist and the caretaker.
Conclusions:
The findings of this study indicate that scapular stabilization may be detrimental to passive stretching of the GH joint in children, as demonstrated by a reduced stretch. Based on the findings of this study, we have changed our practice to recommend passive stretches without scapular stabilization for children aged 5 years and older with brachial plexus birth palsy. In infants and children aged less than 5 years, we now recommend stretching with and without scapular stabilization until the effect of scapular stabilization is objectively assessed in these age groups.
Level Of Evidence/Type Of Study:
Therapeutic IV.
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