Affiliations: [a] Department of Orthopaedics and Rehabilitation, Leiden University Medical Center, Leiden, The Netherlands | [b] Rijnlands Rehabilitation Center, Leiden, The Netherlands
Correspondence:
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Corresponding author: Menno van der Holst, Department of Orthopaedics and Rehabilitation, Leiden University Medical Center, Postal zone H0Q, PO Box 9600, 2300 RC Leiden, The Netherlands. Tel.: +31 71 5263457; Fax: +31 71 5266697; E-mail:m.van_der_holst@lumc.nl
Abstract:
PURPOSE: Shoulder function in children with Neonatal Brachial
Plexus Palsy (NBPP) can be impaired. Functional gain is possible by an
internal contracture release and muscle tendon transfer (ICL+MTT) for
external rotation. This study evaluates the functional results of this
intervention. METHODS: Assessments were done pre-operatively and 3, 6 and 12
months thereafter and included joint-mobility (ROM), muscle strength, arm
function (Assisting Hand Assessment (AHA) and Mallet-score), Quality of Life
(QoL) (Pediatric Outcome Data Collecting Instrument (PODCI)) and parental
satisfaction. Changes were examined using Wilcoxon's Signed-Rank test and
Cohen's effect size. RESULTS: Ten children (5 boys) aged 3-10 years who
underwent a combined ICL+MTT (mm. Latissimus Dorsi/Teres Major) were
included. Active and passive external rotation ROM and muscle strength improved
(p< 0.05). Arm function improved according to the Mallet-score (Hand-to-Head,
Hand-to-Mouth, External-Rotation) (p< 0.05) and the arm use and pace scales
of the AHA (p< 0.05). The PODCI Upper Extremity/Physical Functioning and
Global Functioning subscales also showed improvements (p< 0.05). Parents were
highly satisfied concerning daily life activities and sports. CONCLUSION: ICL+MTT leads to improvement of ROM, strength, arm
function, QoL and high parental satisfaction in this studies' patients and
is therefore a good intervention to consider in children with NBPP with
limited shoulder function.
