Can the Sup-ER Protocol Decrease the Prevalence and Severity of Elbow Flexion Deformity in Brachial Plexus Birth
Leeor Yefet1, Doria Bellows2, Marija Bucevska1
1The University of British Columbia, Vancouver, Canada.
Insights
The Sup-ER protocol, designed for brachial plexus birth injuries (BPBIs), may unintentionally reduce elbow flexion contractures. This study found fewer contractures in children treated with the Sup-ER protocol compared to existing data.
Area of Science:
- Pediatric Orthopedics
- Neuromuscular Disorders
- Rehabilitation Medicine
Background:
- Brachial plexus birth injuries (BPBIs) frequently cause functional deficits, including elbow flexion contractures in up to 48% of cases.
- The Sup-ER protocol, utilizing a custom long-arm orthosis, is established for optimizing glenohumeral joint positioning in BPBI management.
- This study explores the impact of the Sup-ER protocol on elbow flexion contractures, an outcome not directly targeted by the intervention.
Purpose of the Study:
- To investigate the prevalence and severity of elbow flexion contractures in children with BPBI treated with the Sup-ER protocol.
- To compare the incidence of elbow flexion contractures in this cohort against previously published data.
Main Methods:
- A prospective cross-sectional cohort study was conducted on 16 children (age ≥ 4 years) with BPBI requiring the Sup-ER protocol.
- Passive and active elbow range of motion (flexion and extension) were assessed bilaterally.
- Elbow flexion contracture was defined as a passive extension deficit exceeding 5° from neutral.
Main Results:
- The mean maximal passive elbow extension in the affected arm was -6.2°, with 6 out of 16 patients meeting the >5° contracture definition.
- No patients exhibited severe elbow flexion contractures (>30°).
- The mean age of onset for contractures in the affected group was 22 months.
Conclusions:
- Treatment with the Sup-ER protocol appears to be associated with a reduced prevalence and severity of elbow flexion contractures in children with severe BPBI.
- These findings suggest a potential secondary benefit of the Sup-ER protocol in managing elbow joint complications.
- Further research is warranted to confirm these observations and elucidate the underlying mechanisms.
Background:
Brachial plexus birth injuries (BPBIs) can often result in functional and cosmetic deficits including, according to a recent scoping review, elbow flexion contractures in up to 48%. A treatment algorithm that includes a custom long-arm orthosis to optimize early glenohumeral joint positioning (Sup-ER protocol) has been shown to improve shoulder range of motion. Although the protocol was not intentionally designed to affect the elbow, this study investigates the prevalence and severity of elbow flexion contractures in children treated with that protocol.
Methods:
This prospective cross-sectional cohort study examined 16 children aged 4 and older with BPBI severe enough to be treated with the Sup-ER protocol. Passive and active elbow flexion and extension range of motion (ROM) were assessed in both arms. Elbow flexion contractures were defined as > 5o from neutral.
Results:
Within the cohort of 16 patients (mean age: 7.0 years, range: 4.5-11.6 years), the mean maximal passive elbow extension was -6.2° in the affected arm and + 5.1° (hyperextension) in the unaffected arm. Zero patients had a severe elbow flexion contracture (>30o) and only 6/16 met the lowest threshold definition of elbow flexion contracture (>5o), with a mean onset at 22 months of age.
Conclusions:
This study suggests an unintended decreased prevalence and severity of elbow flexion contractures in children with more severe BPBI treated with the Sup-ER protocol, relative to published values.
