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Scapula Stabilizing Vest Improves Abduction Contracture of the Shoulder in Patients with Brachial Plexus Birth Palsy
Kyle R Sochacki, MD1; Michael Moustoukas MD2; Idris S Gharbaoui, MD3; Matthew B. Burn, MD1
1Houston Methodist Hospital, Houston, TX, 2Baylor College of Medicine, Houston, TX , 3Fondren Orthopedic Group, Houston, TX
Introduction: Brachial plexus birth palsy results from injury to one or more of the C5-T1 nerve roots before, during, or after the birth process. Patients that don’t recover are often left with contractures and severe limitations in glenohumeral motion. Paradoxical abduction contractures occur when the glenohumeral joint is tight in the direction of the paralyzed muscles rather than their agonists. In order to fully adduct the arm to the side, these patients use rotation of the scapula on the chest wall resulting in an increased superior scapulohumeral angle. Surgical techniques to treat the abduction contracture have resulted in compensatory reduced shoulder abduction. Scapula stabilizing exercises have been suggested with limited published outcome studies. The purpose of this case series was to determine if a scapula stabilizing vest resulted in improved Mallet scores, scapulohumeral angles, and global glenohumeral arc of motion in patients with abduction contractures of the shoulder secondary to brachial plexus birth palsy.
Materials & Methods: This retrospective case series was approved by our institutional review board. Patients who had a scapula stabilizing vest prescribed for shoulder abduction contracture secondary to brachial plexus birth palsy were identified. Patients who had pre and post-treatment Mallet scores, scapulohumeral angles, and global glenohumeral arc of motion measurements were included. Patients with less than 6 months of follow-up were excluded. Results of the Mallet scores, scapulohumeral angles, and global glenohumeral arc of motion were compared at initiation of treatment and final follow-up.
Results: Eight patients were available for analysis. The average age at initiation of the vest was 7.6 years old. The average follow-up was 1.4 years. Seven patients demonstrated improvement in aggregate Mallet scores. The average aggregate Mallet score improved from 16 at pre-treatment to 18 at final follow-up for an average improvement of 2. The largest improvement was seen in hand to mouth (1) and external rotation (1) Mallet scores. The average posterior scapulohumeral angle improved by 14°(+/- 18°). The average inferior scapulohumeral angle improved by 4°(+/- 15°). The average superior scapulohumeral angle improved by 16°(+/- 25°). Global glenohumeral arc of motion improved by an average of 27° (+/- 17°). No complications from the vest occurred.
Conclusion: The scapula stabilizing vest results in improvement of individual and aggregate Mallet scores, superior scapulohumeral angles, and glenohumeral global arc of motion without compensatory contractures and complications in patients with severe abduction contractures of the glenohumeral joint secondary to brachial plexus birth palsy.
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