Assessment of scapulothoracic and glenohumeral function and conservative treatment approaches for children with brachial plexus birth palsy

Russo, Stephanie A.
Journal Title
Journal ISSN
Volume Title
University of Delaware
Approximately one out of every 1000 live births results in a brachial plexus injury that causes sustained impairments, including reduced strength and range of motion, scapular winging and glenohumeral dysplasia. Children with brachial plexus birth palsy have difficulty with movements such as reaching behind their backs. Early, conservative interventions, such as passive stretching and therapeutic taping, are focused on maximizing range of motion. Clinical assessment of passive range of motion is important for determining appropriate treatment plans. The purpose of this study was to determine which scapulothoracic and glenohumeral motions are needed to reach behind one's back, whether scapular stabilization for passive stretching improves the stretch achieved at the glenohumeral joint, the accuracy of different measurement techniques of glenohumeral and humerothoracic range of motion, and the effect of scapular taping on scapulothoracic and glenohumeral joint function. Children with brachial plexus birth palsy were recruited for this study. Modified Mallet scores and clinical estimates of passive humerothoracic external rotation and glenohumeral cross-body adduction were determined by a pediatric hand surgeon. Humerothoracic external rotation and glenohumeral cross-body adduction were also measured with a goniometer by an occupational therapist. Finally, humerothoracic, scapulothoracic and glenohumeral joint angles were measured using a motion capture system. Subjects held their arms in a neutral, resting position and actively held each of the modified Mallet positions. Additionally, passive cross-body adduction was measured, as well as external rotation and abduction stretches with and without scapular stabilization performed by an occupational therapist. An occupational therapist certified in Kinesio ® taping then applied Kinesio® tape to augment the lower and middle trapezius. Subjects then repeated the neutral position and each of the modified Mallet positions. A combination of glenohumeral extension and internal rotation was needed to achieve the hand to spine position. For passive stretching, scapular stabilization did not increase stretch at the glenohumeral joint; in fact, it was decreased in abduction. There were no significant differences between the clinical estimate, goniometer measure and motion capture measure for glenohumeral cross-body adduction; however, all three measurement techniques were significantly different than each other for humerothoracic external rotation. Finally, Kinesio ® taping reduced scapular winging and demonstrated potential for providing stretch to the glenohumeral joint. The findings of this study support the inclusion of the hand to belly internal rotation position in the modified Mallet classification as a better measure of functional internal rotation than the hand to spine position, which requires both glenohumeral internal rotation and extension. Additionally, scapular stabilization during passive stretching hindered stretch at the glenohumeral joint in the population assessed in this study. However, scapular stabilization may be more effective in infants and this should be investigated further. Performing measurements of joint range of motion over time to monitor progress and assess intervention outcomes by the same clinician using the same measurement technique may reduce the risk of error. Finally, Kinesio ® taping for scapular stabilization has the potential to improve scapulothoracic and glenohumeral joint function; however, further studies are needed to investigate the long-term effects.