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Updated: Mar 19, 2026
Structured Motor Rehabilitation After Selective Nerve Transfers
Published on: August 15, 2019
Passive shoulder mobility and active shoulder external rotation recovery in upper-trunk brachial plexus birth
Eva T E Ulmann1, Jochem Nagels2, Willem Pondaag1
1Department of Neurosurgery, Leiden University Medical Centre, Leiden, Netherlands.
Insights
Active external rotation recovery in children with brachial plexus birth injury (BPBI) is not limited by passive shoulder mobility. This study found passive external rotation improved while active motion lagged after nerve surgery.
Area of Science:
- Pediatric Orthopedics
- Neurology
- Rehabilitation Medicine
Background:
- Brachial plexus birth injury (BPBI) affects shoulder function in children.
- Restoring active external rotation is crucial for upper limb function after nerve surgery for BPBI.
Purpose of the Study:
- To investigate the relationship between active shoulder external rotation and passive glenohumeral mobility in children with upper-trunk BPBI post-nerve surgery.
- To determine if passive mobility limits active recovery.
Main Methods:
- Retrospective analysis of children with upper-trunk BPBI undergoing primary C5/C6 spinal nerve surgery.
- Longitudinal assessment of passive and active external rotation at multiple ages (1-15 years).
- Statistical analysis using linear mixed models, adjusted for diagnosis and surgical strategy.
Main Results:
- Active external rotation improved by 2.1°/year, while passive external rotation decreased by 2.6°/year.
- A significant difference between passive and active external rotation persisted, decreasing by 4.5°/year.
- At 15 years, a 36° difference remained, indicating active motion did not fully catch up to passive range.
Conclusions:
- Passive glenohumeral mobility does not appear to be the primary limiting factor for active external rotation recovery after nerve surgery in pediatric BPBI.
- Further research is needed to identify other factors influencing active external rotation deficits.
Aim:
To examine the relationship between active shoulder external rotation recovery and passive glenohumeral mobility in children with upper-trunk brachial plexus birth injury (BPBI) after nerve surgery.
Method:
This retrospective analysis included children with upper-trunk BPBI who underwent primary surgery of the C5 and/or C6 spinal nerves with 2 or more years of follow-up. Linear mixed models were used to analyse passive and active external rotation in adduction at ages 1, 3, 5, 7, and 15 years, adjusted for diagnosis and suprascapular nerve reconstruction strategy (grafting, transfer, neurolysis).
Results:
We included 322 children (142 males and 180 females), with a mean (SD) follow-up of 7 years 7 months (4 years 7 months); median age at surgery was 5 months (interquartile range = 4-6 months). Active external rotation increased on average by 2.1° per year (95% confidence interval [CI] = 1.4° to 2.8°, p < 0.001), while passive external rotation decreased on average by 2.6° per year (95% CI = 2.2° to 3.0°, p < 0.001). Passive external rotation was on average 65° (95% CI = 62° to 68°, p < 0.001) greater than active external rotation. The difference decreased by 4.5° per year (95% CI = 3.8° to 5.2°, p < 0.001). At age 15 years, a difference of 36° (95% CI = 29° to 43°) remained.
Interpretation:
Passive external rotation is not the explanatory limiting factor in the restoration of active external rotation after nerve surgery in children with upper-trunk BPBI.
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