Affiliations: [a] Division of Plastic and Reconstructive Surgery, The Hospital for Sick Children, Toronto, ON, Canada | [b] Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada | [c] Department of Surgery, University of Toronto, Toronto, ON, Canada | [d] Division of Orthopedics, The Hospital for Sick Children, Toronto, ON, Canada | [e] Bloorview Research Institute, Toronto, ON, Canada | [f] Department of Physical Therapy, University of Toronto, Toronto, ON, Canada
Correspondence:
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Corresponding author: Emily S. Ho, The Hospital for Sick Children, %****␣prm-12-prm180563_temp.tex␣Line␣25␣**** 555 University Avenue, Rm 5433, Toronto, Ontario M5G 1X8, Canada. Tel.: +1 416 813 8270; Fax: +1 416 813 8557; E-mail: emily.ho@sickkids.ca.
Abstract: PURPOSE: To conduct a systematic review of studies on non-surgical and surgical interventions for elbow flexion contractures secondary to brachial plexus birth injury (BPBI). METHODS: MEDLINE, EMBASE, PsycINFO, and CINAHL databases were searched for randomized controlled trials, observational studies, and case series studies on treatment of elbow flexion contractures secondary to BPBI. Study quality was evaluated using the Effective Public Health Practice Project tool. RESULTS: Of the 950 records found, 132 full text articles were reviewed, and 3 cohort studies and 8 case series were included. The overall methodological quality of included studies was weak. The weak quality evidence demonstrated that significant gains in elbow extension passive range of motion (ROM) can be achieved with serial casting (range: 15 to 34.5 degrees) or elbow release surgery (range: 28.4 to 30.0 degrees). At best, a reduction to an elbow contracture between -15.0 and -18.8 degrees (casting) and -8.0 and -43.6 (elbow release surgery) can be achieved. Insufficient outcomes on elbow flexion ROM and strength were found in both non-surgical and surgical studies. CONCLUSION: The quality of evidence on the effectiveness of interventions for an elbow flexion contracture secondary to BPBI is weak. In the context of insufficient evidence on the risks of pursuing such interventions, it is prudent to attempt non-surgical interventions prior to surgery. Level of Evidence: III – systematic review of level IV studies
