Article

Children with neonatal brachial plexus palsy (NBPP) are often
prescribed shoulder range of motion (ROM) exercises ; however, the extent and
timing of exercise implementation remains controversial in the context of
shoulder joint integrity. The association of ROM exercises to delayed posterior
shoulder subluxation (PSS)
is unknown. OBJECTIVE: To determine prevalence of PSS
in children with NBPP who began full passive ROM exercises before 6 months of
age, and characteristics associated with development or absence of PSS in
children. DESIGN: Cross-sectional study. SETTING: Tertiary care NBPP referral
center. PARTICIPANTS: Forty-six children with NBPP, aged 24-57 months, who began
full ROM exercises before 6 months of age. METHODS:
One radiologist conducted
bilateral shoulder ultrasound (US) on each child to evaluate for PSS. One
occupational therapist evaluated each child clinically for PSS using defined
parameters without knowledge of US results. MAIN OUTCOME MEASURES: By US, 20% of
children had PSS; 46% had PSS by clinical examination. Shoulder active ROM
limitations and history of shoulder surgery were associated with presence of PSS.
Extent of NBPP was not associated with PSS. RESULTS: Nine of 46 children (20%)
met US criteria for PSS; alpha angle was 58 degrees +/- 21 degrees (mean +/-
standard deviation [SD]). Twenty-one children (46%) met clinical criteria. Mean
age at examination was 35 +/- 10 months. Shoulder active ROM
(P </= .004) was
associated with PSS, whereas passive ROM was not (P >/= .08). History of
secondary shoulder surgery and primary nerve graft repair were associated with
PSS (P = .04). Extent of NBPP by Narakas classification was not associated with
PSS (P = .48). CONCLUSIONS: Early use of full-arc passive ROM home exercise
program is not associated with increased prevalence of PSS in children with NBPP
compared to prevalence of PSS in published literature. We suggest careful
clinical examination, based on defined criteria, provides a reasonable screening
examination for evaluating PSS that can be confirmed by noninvasive US.
CI - Copyright (c) 2015 American Academy of Physical Medicine and Rehabilitation.
Published by Elsevier Inc.
All rights reserved.

Langue : ANGLAIS