Degree of Contracture Related to Residual Muscle Shoulder Strength in Children with Obstetric Brachial Plexus Lesions

Abstract

Background and Objectives Little is known about the relation between residual muscle strength and joint contracture formation in neuromuscular disorders. This study aimed to investigate the relation between residual muscle strength and shoulder joint contractures in children with sequelae of obstetric brachial plexus lesion (OBPL). In OBPL a shoulder joint contracture is a frequent finding. We hypothesize that residual internal and external rotator strength and their balance are related to the extent of shoulder joint contracture.

Methods Clinical assessment was performed in 34 children (mean 10.0 years) with unilateral OBPL and Narakas classes I–III. External and internal rotation strengths were measured with the shoulder in neutral position using a handheld dynamometer. Strength on the affected side was given as percentage of the normal side. Contracture was assessed by passive internal and external rotations in degrees (in 0° abduction). Mallet classification was used for active shoulder function.

Results External and internal rotation strengths on the affected side were approximately 50% of the normal side and on average both equally affected: 56% (SD 18%) respectively 51% (SD 27%); r = 0.600, p = 0.000. Residual strengths were not related to passive internal or external rotation (p > 0.200). Internal rotation strength (r =  − 0.425, p <0.05) was related to Narakas class. Mallet score was related to external and internal rotation strengths (r = 0.451 and r = 0.515, respectively; p < 0.01).

Conclusion The intuitive notion that imbalances in residual muscle strength influence contracture formation cannot be confirmed in this study. Our results are of interest for the understanding of contracture formation in OBPL.

Keywords

obstetric brachial plexus lesion - contracture - muscle force/strength - shoulder function

• References

• 1 Evans-Jones G, Kay SP, Weindling AM , et al. Congenital brachial palsy: incidence, causes, and outcome in the United Kingdom and Republic of Ireland. Arch Dis Child Fetal Neonatal Ed 2003; 88 (3) F185-F189
• 2 Hoeksma AF, Ter Steeg AM, Dijkstra P, Nelissen RG, Beelen A, de Jong BA. Shoulder contracture and osseous deformity in obstetrical brachial plexus injuries. J Bone Joint Surg Am 2003; 85-A (2) 316-322
• 3 Hale HB, Bae DS, Waters PM. Current concepts in the management of brachial plexus birth palsy. J Hand Surg Am 2010; 35 (2) 322-331
• 4 Pearl ML. Shoulder problems in children with brachial plexus birth palsy: evaluation and management. J Am Acad Orthop Surg 2009; 17 (4) 242-254
• 5 Waters PM, Monica JT, Earp BE, Zurakowski D, Bae DS. Correlation of radiographic muscle cross-sectional area with glenohumeral deformity in children with brachial plexus birth palsy. J Bone Joint Surg Am 2009; 91 (10) 2367-2375
• 6 Hultgren T, Einarsson F, Runesson E, Hemlin C, Fridén J, Ljung BO. Structural characteristics of the subscapularis muscle in children with medial rotation contracture of the shoulder after obstetric brachial plexus injury. J Hand Surg Eur Vol 2010; 35 (1) 23-28
• 7 Nikolaou S, Peterson E, Kim A, Wylie C, Cornwall R. Impaired growth of denervated muscle contributes to contracture formation following neonatal brachial plexus injury. J Bone Joint Surg Am 2011; 93 (5) 461-470
• 8 Einarsson F, Hultgren T, Ljung BO, Runesson E, Fridén J. Subscapularis muscle mechanics in children with obstetric brachial plexus palsy. J Hand Surg Eur Vol 2008; 33 (4) 507-512
• 9 Van Gelein Vitringa VM, Jaspers R, Mullender M, Ouwerkerk WJ, Van Der Sluijs JA. Early effects of muscle atrophy on shoulder joint development in infants with unilateral birth brachial plexus injury. Dev Med Child Neurol 2011; 53 (2) 173-178
• 10 Ruoff JM, van der Sluijs JA, van Ouwerkerk WJ, Jaspers RT. Musculoskeletal growth in the upper arm in infants after obstetric brachial plexus lesions and its relation with residual muscle function. Dev Med Child Neurol 2012; 54 (11) 1050-1056
• 11 Kirjavainen MO, Nietosvaara Y, Rautakorpi SM , et al. Range of motion and strength after surgery for brachial plexus birth palsy. Acta Orthop 2011; 82 (1) 69-75
• 12 Kim HM, Galatz LM, Patel N, Das R, Thomopoulos S. Recovery potential after postnatal shoulder paralysis. An animal model of neonatal brachial plexus palsy. J Bone Joint Surg Am 2009; 91 (4) 879-891
• 13 Zyluk A, Jagielski W. The effect of the severity of the Dupuytren's contracture on the function of the hand before and after surgery. J Hand Surg Eur Vol 2007; 32 (3) 326-329
• 14 Ada L, O'Dwyer N, O'Neill E. Relation between spasticity, weakness and contracture of the elbow flexors and upper limb activity after stroke: an observational study. Disabil Rehabil 2006; 28 (13–14) 891-897
• 15 Mallet J. Obstetrical paralysis of the brachial plexus. II. Therapeutics. Treatment of sequelae. Priority for the treatment of the shoulder. Method for the expression of results [in French]. Rev Chir Orthop Repar Appar Mot 1972; 58: 1 , 166–168
• 16 Narakas AO. Obstetrical brachial plexus injuries. In: Lamb D, , ed. The Paralysed Hand. Edinburgh, UK: Churchill Livingstone; 1987: 116-135
• 17 Hébert LJ, Maltais DB, Lepage C, Saulnier J, Crête M, Perron M. Isometric muscle strength in youth assessed by hand-held dynamometry: a feasibility, reliability, and validity study. Pediatr Phys Ther 2011; 23 (3) 289-299
• 18 Boettcher CE, Cathers I, Ginn KA. The role of shoulder muscles is task specific. J Sci Med Sport 2010; 13 (6) 651-656
• 19 Escamilla RF, Yamashiro K, Paulos L, Andrews JR. Shoulder muscle activity and function in common shoulder rehabilitation exercises. Sports Med 2009; 39 (8) 663-685
• 20 Huijing PA, Jaspers RT. Adaptation of muscle size and myofascial force transmission: a review and some new experimental results. Scand J Med Sci Sports 2005; 15 (6) 349-380
• 21 Zatsiorsky VM, Prilutsky BI. Biomechanics of Skeletal Muscles. Leeds, UK: Human Kinetics; 2012
• 22 Williams PE, Goldspink G. Changes in sarcomere length and physiological properties in immobilized muscle. J Anat 1978; 127 (Pt 3): 459-468
• 23 Koh TJ, Herzog W. Excursion is important in regulating sarcomere number in the growing rabbit tibialis anterior. J Physiol 1998; 508 (Pt 1): 267-280
• 24 Hogendoorn S, van Overvest KL, Watt I, Duijsens AH, Nelissen RG. Structural changes in muscle and glenohumeral joint deformity in neonatal brachial plexus palsy. J Bone Joint Surg Am 2010; 92 (4) 935-942
• 25 Pöyhiä TH, Nietosvaara YA, Remes VM, Kirjavainen MO, Peltonen JI, Lamminen AE. MRI of rotator cuff muscle atrophy in relation to glenohumeral joint incongruence in brachial plexus birth injury. Pediatr Radiol 2005; 35 (4) 402-409
• 26 Waters PM, Smith GR, Jaramillo D. Glenohumeral deformity secondary to brachial plexus birth palsy. J Bone Joint Surg Am 1998; 80 (5) 668-677
• 27 van Gelein Vitringa VM, van Kooten EO, Jaspers RT, Mullender MG, van Doorn-Loogman MH, van der Sluijs JA. An MRI study on the relations between muscle atrophy, shoulder function and glenohumeral deformity in shoulders of children with obstetric brachial plexus injury. J Brachial Plex Peripher Nerve Inj 2009; 4: 9