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Bilateral Hand Dexterity in Children with C5-C6 Birth Brachial Plexus Palsy
Derek T Bernstein, MD1; Gloria R Gogola, MD2
1Houston Methodist Hospital, Houston, TX, 2Shriners Hospitals for Children, Houston, TX
Introduction: Children with an isolated C5-C6 birth brachial plexus palsy (BBPP) are presumed to have normal ipsilateral hand function; however, clinical observation suggests atypical bimanual hand use. We hypothesize that when specifically testing dexterity, the ipsilateral hand would show deficits while the contralateral hand would resemble that of typically-developing children.
Materials & Methods: Data from thirty-two pediatric patients with isolated C5-C6 BBPP were reviewed, including age, gender, prior shoulder surgery, modified Mallet score, and FDT (Functional Dexterity Test) score. The FDT speeds of each hand were evaluated against age-matched norms. Kendall’s tau b was employed to correlate FDT performance with self-assessment of ipsilateral hand function and the modified Mallet score. Student’s T-test was employed to determine if FDT speed was affected by gender or prior shoulder surgery.
Results: The average patient age was 8.5 years (range: 3-17) with an equal gender ratio. BBPP affected the left side in nine patients (all right-hand-dominant), and the right side in twenty-three patients (nineteen were left-hand-dominant). Twelve patients had no prior surgeries. Twenty patients had undergone secondary procedures about the shoulder. The average modified Mallet aggregate was 20.7 (range: 15-24). Patients with C5-C6 BBPP performed worse than age and hand dominance-matched norms with the affected (p=0.0003) and unaffected hands (p=0.0001). This discrepancy worsened bilaterally with age. There was no significant difference between affected and unaffected hands (p=0.456); typically-developing children demonstrate a consistent difference between dominant and non-dominant hands throughout growth. FDT speed was not influenced by gender (p=0.631) or prior surgical intervention (p=0.563). There was no correlation with self-assessment of the affected hand (p=0.861) or modified Mallet aggregate score (p=0.416).
Conclusion: Children with upper plexus lesions demonstrate diminished dexterity with both the ipsilateral and contralateral hands. These deficits increase with age, suggesting that these children progress slower than typically-developing peers. The severity of shoulder impairment (modified Mallet score, shoulder surgery) did not correlate with hand dexterity. This study highlights the need to address bilateral hand function in the treatment of children with C5-C6 BBPP.
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