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Updated: Jun 25, 2025
Methods for In Vivo Biomechanical Testing on Brachial Plexus in Neonatal Piglets
Published on: December 19, 2019
Shoulder external rotation contracture following neonatal brachial plexus injury
Dragos Hutanu1, Pablo S Corona2, Juliana Rojas-Neira3
1George Emil Palade University of Medicine, Pharmacy, Science and Technology, Targu Mures, Romania.
Insights
Posterior external rotation contractures are common in neonatal brachial plexus injury (NBPI), affecting midline access. Procedures and injury severity did not predict the inability to reach the belly, suggesting specific thresholds for function.
Area of Science:
- Orthopedics
- Pediatric Surgery
- Neurology
Background:
- Posterior glenohumeral external rotation contractures and scapular winging are often overlooked in residual neonatal brachial plexus injury (NBPI).
- These conditions significantly impact essential functions like feeding and hygiene.
- This study focuses on the epidemiology of these contractures in pediatric NBPI.
Purpose of the Study:
- To determine the prevalence of posterior glenohumeral contractures in pediatric NBPI patients.
- To identify factors contributing to the development of these contractures.
- To explore the relationship between contractures and functional outcomes, specifically midline access.
Main Methods:
- Retrospective analysis of 262 children with residual NBPI from January 2019 to November 2022.
- Data collected included demographics, palsy level, surgical history, and modified Mallet scale scores.
- Measurements of glenohumeral passive internal rotation in abduction and cross-body adduction angles were taken bilaterally.
Main Results:
- Contractures were prevalent, with many patients exceeding 10°, 20°, and 30° in both measured angles.
- The 'Belly-' group (Mallet hand-to-belly <3) showed significantly reduced range of motion compared to the 'Belly+' group.
- While glenohumeral reduction and Hoffer procedures decreased cross-body adduction, they did not impact 'Belly-' prevalence.
Conclusions:
- Posterior external rotation glenohumeral contractures are common in residual NBPI and limit midline access.
- Contrary to expectations, prior surgeries or extensive injuries did not correlate with a higher likelihood of losing the ability to reach the belly.
- Specific thresholds identified via ROC analysis may predict the ability to maintain midline access.
Background:
Glenohumeral posterior external rotation contractures and scapular winging are frequently overlooked problems in residual neonatal brachial plexus injury (NBPI). Recent attention has emphasized their impact on vital functions such as feeding and hygiene. This study aims to present the epidemiology of posterior glenohumeral contractures in a significant pediatric NBPI population and explore contributing factors.
Methods:
We conducted a retrospective analysis of data collected from January 2019 to November 2022, involving a case series of 262 children with residual NBPI. The data included demographics, palsy level, prior surgical history, and the modified Mallet scale. Glenohumeral passive internal rotation in abduction and cross-body adduction angles were measured bilaterally. Subjects were categorized into "Belly-" (Mallet hand-to-belly <3) and "Belly+" (Mallet hand-to-belly ≥3) groups.
Results:
The median participant age was 7.9 years (range: 3.5-21 years). Extension injury patterns included Erb's palsy (56.5%), extended Erb's palsy (28.6%), and global palsy (14.9%). Contractures exceeding 10°, 20°, and 30° were prevalent in both internal rotation in abduction and cross-body adduction angles. The "Belly-" group (9.5%) demonstrated a significant reduction in both angles compared to the "Belly+" group. Weak correlations were found between internal rotation in abduction (r = 0.390, P < .0001) or cross-body adduction (r = 0.163, P = .0083) angles and Mallet hand-to-abdomen item. Glenohumeral reduction and Hoffer procedures led to a notable decrease in cross-body adduction angle, without affecting "Belly-" prevalence. Global injuries exhibited decreased angles compared to Erb's group.
Conclusions:
External rotation glenohumeral contractures are prevalent in residual NBPI, impacting midline access. Surprisingly, the history of glenohumeral procedures or extensive injuries did not increase the likelihood of losing the ability to reach the belly. Receiver operating characteristic analysis suggests specific thresholds for maintaining this ability.
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