Category: Pediatric Rehabilitation; Clinical Practice (assessment, diagnosis, treatment, knowledge translation/EBP, implementation science, program development)
To describe the incidence of shoulder subluxation among infants with brachial plexus birth palsy and estimate associations between shoulder subluxation and clinical objective measures.
Design : Retrospective cohort study
Outpatient multi-disciplinary brachial plexus clinic
Participants (or Animals, Specimens, Cadavers) : Infants aged 1-48 months seen between 2011-2017 and underwent ultrasound shoulder evaluation at 3 months of age. Exclusion criteria included shoulder splint positioning or full recovery by 3 months of age and first ultrasound obtained at >12 months of age. Of 267 patients who presented to our clinic, 66 subjects were included in the study.
Interventions : Ultrasound of bilateral shoulders at 3 and 6 months of age. Results were then used to guide shoulder treatment according to established clinic treatment protocols.
Main Outcome Measure(s) : Incidence of shoulder subluxation on early ultrasound, defined as alpha angle >30 degrees. Additionally, evaluating clinical assessments with logistic regression to see if any were predictive of subluxation. For passive range of motion, we looked at sensitivity and specificity of detecting shoulder subluxation.
Results : 56.1% of subjects were female with a mean gestational age of 39 weeks (SD 1.54) and birth weight of 4.16 kg (SD 0.64). Mean time to US was 16.6 weeks (SD 7.7) and incidence of shoulder subluxation was 89.4%. The only significant predictor of abnormal alpha angle was PROM for external rotation (OR 7.8, p = 0.036 and CI 1.1-52.5). However, 74.2% of infants had full PROM. The associated sensitivity for PROM was 35.7% and specificity was 91.7%.
Shoulder subluxation is seen in the majority of patients at 3 months of age. Our incidence of shoulder subluxation is higher than reported in previous studies. Clinical assessment predictors such as full PROM are not indicative of a normal alpha angle.
Stephanie Hendrick– Fellow , Shirley Ryan AbilityLab, Chicago, Illinois
Marisa Osorio– Assistant Professor, University of Washington/Seattle Children's Hospital, Seattle, Washington
Sarah Lewis– Physical Therapist, Seattle Children's Hospital, Seattle, Washington
Raymond Tse– Associate Professor, University of Washington, Seattle, Washington