Purpose
The purpose of this study was to examine radiographic and functional outcomes of the
shoulder in brachial plexus birth injury (BPBI) patients at long-term follow-up.
Methods
Medical records were reviewed at the Shriners Hospital in St. Louis to identify patients
older than 18 years with a diagnosis of BPBI. Twenty-five patients were included in
this study. Evaluations included radiographic examination, clinical examination, and
outcome measures including the Mallet classification, visual analog scale (VAS) for
shoulder pain, American Shoulder and Elbow Shoulder score (ASES), quick Disabilities
of the Arm, Shoulder, and Hand (QuickDASH), Simple Shoulder Test (SST), and Patient-Reported Outcomes Measurement Information
System (PROMIS) domain measures.
Results
The mean age of the patients included was 44 years. Average follow-up was 37 years.
No patient had primary nerve reconstruction surgery. Thirteen patients had a history
of shoulder surgery at an average age of 6 years. There was a wide spectrum of deformity
seen radiographically. Fifty-five percent of patients had evidence of glenoid retroversion,
posterior humeral translation, or a biconcave glenoid. An additional 20% of patients
had complete posterior dislocation of the humeral head. Despite the degenerative changes
seen on radiographs, the mean VAS for pain was low, at 2. The mean ASES shoulder score
was 54. The mean QuickDASH score was 30. Mean PROMIS Physical Function, Pain Interference, Depression, and
Anxiety scores were near the means for the general population, with similar outcomes
in patients treated with shoulder surgery compared with those treated without surgery.
Conclusions
Adult BPBI patients experience minimal shoulder pain despite deformity and degenerative
changes on shoulder radiographs. Whereas there are significant deficits in range of
motion and function, PROMIS scores in adult BPBI patients are normal.
Type of study/level of evidence
Therapeutic IV.
Key words
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Article info
Publication history
Published online: October 23, 2020
Accepted:
September 11,
2020
Received:
January 2,
2019
Footnotes
No benefits in any form have been received or will be received related directly or indirectly to the subject of this article.
Identification
Copyright
© 2020 by the American Society for Surgery of the Hand. All rights reserved.
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