Prevalence and predictors of elbow flexion contractures during early childhood following brachial plexus birth injury.

Autor: Ogilvie KM; Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, Canada; Alberta Health Services, Calgary, Canada., Mah AML; Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, Canada; Sunnybrook Health Sciences Centre, Toronto, Canada., Klar K; Division of Plastic and Reconstructive Surgery, The Hospital for Sick Children, Toronto, Canada., Anthony A; Division of Plastic and Reconstructive Surgery, The Hospital for Sick Children, Toronto, Canada., Davidge KM; Division of Plastic and Reconstructive Surgery, The Hospital for Sick Children, Toronto, Canada., Clarke HM; Division of Plastic and Reconstructive Surgery, The Hospital for Sick Children, Toronto, Canada; Department of Surgery, University of Toronto, Toronto, Canada., Ho ES; Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, Canada; Division of Plastic and Reconstructive Surgery, The Hospital for Sick Children, Toronto, Canada. Electronic address: emily.ho@sickkids.ca.
Jazyk: angličtina
Zdroj: Journal of hand therapy : official journal of the American Society of Hand Therapists [J Hand Ther] 2024 Jul-Sep; Vol. 37 (3), pp. 446-452. Date of Electronic Publication: 2024 Feb 10.
DOI: 10.1016/j.jht.2023.09.003
Abstrakt: Background: Elbow flexion contracture development in school-age children with a brachial plexus birth injury (BPBI) is common. Reports indicate onset between 2 and 4 years; however, little is known about early childhood prevalence, development, and trajectory of these contractures.
Purpose: To determine the prevalence and predictors of BPBI elbow flexion contractures during early childhood.
Study Design: A retrospective cross-sectional study.
Methods: Demographic, diagnostic, treatment, and elbow contracture data were collected for children with a BPBI <4 years between 2015 and 2019 from a prospectively collected database. Spinal root motor contributions and injury were determined using Active Movement Scale (AMS) scores at 6 weeks of age and used to predict contracture development.
Results: Of the 171 children that met inclusion criteria, 87% (n = 149) had upper plexus injuries. The mean age at the time of evaluation for an elbow contracture was 21.4 ± 12.7 months. The prevalence of elbow flexion contractures was 22% (n = 38), with mean onset at 13.4 ± 11.0 months. Mean contracture degree was -10.8 ± -6.9 degrees with 76% (n = 29) <-10 degrees. AMS shoulder abduction, flexion, and external rotation; elbow flexion; forearm supination; and wrist extension scores at a mean 2.3 ± 1.4 months were significantly lower in children who developed elbow flexion contractures (p < 0.001). Logistic regression found that low AMS elbow flexion with high elbow extension scores were a significant (p < 0.003) predictor of elbow contracture development.
Conclusions: The prevalence of elbow flexion contractures in early childhood is greater than previously understood. These findings indicate that C5-C6 injury affecting elbow flexion with relative preservation of elbow extension is a predictor of contracture development. Further research is needed to investigate the nature and sequelae of C5-C6 injury and its effects on elbow flexion contracture development.
Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.
(Copyright © 2024 Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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