- 作者：Stephanie A. Russo ; Scott H. Kozin ; Dan A. Zlotolow ; Kristen F. Thomas ; Robert L. Hulbert ; Jeffrey M. Mattson ; K. Michael Rowley ; James G. Richards
- 关键词：Basic Science Study ; Kinematics
- 刊名：Journal of Shoulder and Elbow Surgery
- 出版年：March, 2014
- 年：2014
- 卷：23
- 期：3
- 页码：327-338
- 全文大小：1858 K
Background
Brachial plexus birth palsy occurs in 0.4 to 4.6 of every 1000 live births, with residual shoulder dysfunction in approximately one third of cases. Clinical measures, such as the Mallet classification, provide no insight into the scapulothoracic and glenohumeral contributions to tested global shoulder movements. This study describes the scapulothoracic and glenohumeral components of shoulder motion during the modified Mallet test.Methods
Twelve children with Erb鈥檚 palsy (C5-6) and 8 children with extended Erb鈥檚 palsy (C5-7) were recruited. The unaffected limbs of 6 subjects were also tested. Locations of markers placed on the thorax, humerus, and scapula were recorded in a neutral position and each of the modified Mallet positions. Scapulothoracic, glenohumeral, and humerothoracic helical displacements and acromion process linear displacements were compared between groups.
Results
The brachial plexus birth palsy groups exhibited significantly smaller glenohumeral displacements in all modified Mallet positions and significantly larger scapulothoracic displacements in the global external rotation and hand to mouth positions. Discriminant function analysis using only humerothoracic variables correctly classified 76.9% of subjects. Discriminant function analysis incorporating scapulothoracic, glenohumeral, and acromion process displacement variables produced accuracy of 92.6%.
Conclusions
Children with brachial plexus birth palsy demonstrated decreased glenohumeral contributions to achieve every modified Mallet position and increased scapulothoracic contribution in two positions compared with the unaffected group. Different scapulothoracic and glenohumeral strategies were identified between groups. Finally, scapulothoracic and glenohumeral components of shoulder motion are more specific than humerothoracic measures to diagnostic classification.