Prevalence and predictors of elbow flexion contractures during early childhood following brachial plexus birth injury

Karen M Ogilvie; Allison M L Mah; Karen Klar; Alison Anthony; Kristen M Davidge; Howard M Clarke; Emily S Ho

doi:10.1016/j.jht.2023.09.003

Prevalence and predictors of elbow flexion contractures during early childhood following brachial plexus birth injury

J Hand Ther. 2024 Feb 10:S0894-1130(23)00130-8. doi: 10.1016/j.jht.2023.09.003. Online ahead of print.

Authors

Karen M Ogilvie¹, Allison M L Mah², Karen Klar³, Alison Anthony³, Kristen M Davidge³, Howard M Clarke⁴, Emily S Ho⁵

Affiliations

¹ Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, Canada; Alberta Health Services, Calgary, Canada.
² Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, Canada; Sunnybrook Health Sciences Centre, Toronto, Canada.
³ Division of Plastic and Reconstructive Surgery, The Hospital for Sick Children, Toronto, Canada.
⁴ Division of Plastic and Reconstructive Surgery, The Hospital for Sick Children, Toronto, Canada; Department of Surgery, University of Toronto, Toronto, Canada.
⁵ Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, Canada; Division of Plastic and Reconstructive Surgery, The Hospital for Sick Children, Toronto, Canada. Electronic address: emily.ho@sickkids.ca.

PMID: 38342639
DOI: 10.1016/j.jht.2023.09.003

Abstract

Background: Elbow flexion contracture development in school-age children with a brachial plexus birth injury (BPBI) is common. Reports indicate onset between 2 and 4 years; however, little is known about early childhood prevalence, development, and trajectory of these contractures.

Purpose: To determine the prevalence and predictors of BPBI elbow flexion contractures during early childhood.

Study design: A retrospective cross-sectional study.

Methods: Demographic, diagnostic, treatment, and elbow contracture data were collected for children with a BPBI <4 years between 2015 and 2019 from a prospectively collected database. Spinal root motor contributions and injury were determined using Active Movement Scale (AMS) scores at 6 weeks of age and used to predict contracture development.

Results: Of the 171 children that met inclusion criteria, 87% (n = 149) had upper plexus injuries. The mean age at the time of evaluation for an elbow contracture was 21.4 ± 12.7 months. The prevalence of elbow flexion contractures was 22% (n = 38), with mean onset at 13.4 ± 11.0 months. Mean contracture degree was -10.8 ± -6.9 degrees with 76% (n = 29) <-10 degrees. AMS shoulder abduction, flexion, and external rotation; elbow flexion; forearm supination; and wrist extension scores at a mean 2.3 ± 1.4 months were significantly lower in children who developed elbow flexion contractures (p < 0.001). Logistic regression found that low AMS elbow flexion with high elbow extension scores were a significant (p < 0.003) predictor of elbow contracture development.

Conclusions: The prevalence of elbow flexion contractures in early childhood is greater than previously understood. These findings indicate that C5-C6 injury affecting elbow flexion with relative preservation of elbow extension is a predictor of contracture development. Further research is needed to investigate the nature and sequelae of C5-C6 injury and its effects on elbow flexion contracture development.

Keywords: Brachial plexus birth injury; Early childhood; Elbow flexion contracture; Infancy.