Investigation of Upper Extremity Resting Position in Children with Brachial Plexus Birth Injury

ABSTRACT

Purpose: The aim of our study was to investigate the resting position of the upper extremity in different types of nerve injury in brachial plexus birth injury (BPBI).

Method: A total of 193 children aged 4-18 years with BPBI were included in the study. The results of the children's routine physiotherapy assessments were analyzed retrospectively. Resting position of the upper extremity and upper extremity function were assessed using the Modified Mallet Classification. Differences in both global upper extremity resting position and forearm resting position between Narakas types were analyzed, and also the relationship between upper limb resting position and age and function was investigated.

Results: There was a statistical difference in the distribution of the resting position of the upper extremity according to Narakas types (p<0.001). In upper trunk injuries, there was a moderate positive correlation between upper extremity resting position and total function of the upper extremity (p<0.001, r=0.605). Also, there was a moderate negative correlation between age and grade of the upper extremity resting position in children with total plexus injury (p=0.016, r=-0.423).

Discussion: Increased shoulder internal rotation posture could be seen in all upper trunk injuries and was more common in Narakas type 2b, which also has a negative effect on total upper extremity function. It was found that for both total plexus and upper trunk injuries, the resting forearm posture could be in either supination or pronation. Supination position was more common, particularly in total plexus injuries and Narakas type 2b.

Key Words: Birth Injury, Brachial Plexus, Posture, Upper Extremity, Physiotherapy.