A protocol-based treatment plan to improve shoulder function in children with brachial plexus birth injury: a...

Area of Science:

• Pediatric Orthopedics
• Neuromuscular Disorders
• Rehabilitation Medicine

Background:

• Children with permanent brachial plexus birth injury face a high risk of posterior shoulder subluxation.
• This condition can lead to significant functional deficits and require surgical intervention.

Purpose of the Study:

• To evaluate the effectiveness of a comprehensive protocol implemented in 2010 to reduce the incidence of posterior shoulder subluxation in children with brachial plexus birth injury.
• To assess the impact of the protocol on the age of subluxation detection, need for surgery, and shoulder range of motion.

Main Methods:

• A retrospective review of 237 children with brachial plexus birth injury treated between 1995 and 2019.
• Children were divided into three groups based on birth year: 1995-1999, 2000-2009, and 2010-2019.
• The protocol included early passive exercises, ultrasound screening, botulinum toxin-A injections, shoulder splinting, and targeted surgeries.

Main Results:

• Posterior shoulder subluxation occurred in 48% of all patients.
• The mean age of subluxation detection decreased significantly from 5 years to 4.9 months after protocol implementation.
• The need for shoulder relocation surgery decreased from 28% to 7%, and mean active shoulder external rotation in adduction improved from 2° to 46°.

Conclusions:

• The established protocol demonstrates a significant potential to reduce the incidence of posterior shoulder subluxation in children with brachial plexus birth injury.
• Early detection and intervention through this protocol lead to improved clinical outcomes, including reduced surgical necessity and enhanced shoulder function.