Clinical measurements for inferior, posterior, and superior glenohumeral joint contracture evaluation in children with brachial plexus birth palsy: intraobserver and interobserver reliability

J Shoulder Elbow Surg. 2018 Oct;27(10):1779-1784. doi: 10.1016/j.jse.2018.04.014. Epub 2018 May 30.


Background: Glenohumeral (GH) contractures appear in most patients with incomplete motor recovery as a result of progressive development of periarticular muscle contractures. The objectives of this study were to describe a method to measure the passive range of motion of the glenohumeral joint (GHJ) in patients with brachial plexus birth palsy (BPBP) and to evaluate its intraobserver and interobserver reproducibility.

Methods: Three orthopedic surgeons measured the passive GHJ mobility of 25 patients older than 4 years with unilateral BPBP. Measurements were performed twice on both shoulders. They comprised the spinohumeral abduction angle (SHABD), spinohumeral adduction angle (SHADD), GH cross-body adduction (CBADD), and GH internal rotation in abduction (IRABD). Anterior GH contracture was not evaluated.

Results: Passive shoulder measurements obtained from the uninvolved and involved shoulders were as follows: SHABD, 42° and 18°, respectively; SHADD, 14° and -1°, respectively; CBADD, 71° and 41°, respectively; and IRABD, 54° and 37°, respectively. Contracture of the lower portion of the involved GHJ was observed in 18 of 25 patients (72%); the upper portion, in 16 of 25 (64%); and the posterior portion, in 22 of 25 (88%). Interobserver variation (intraclass correlation coefficient) was 0.91 (excellent) for SHABD, 0.63 (good) for SHADD, 0.86 (excellent) for CBADD, and 0.67 (good) for IRABD. Intraobserver variation (intraclass correlation coefficient) was 0.94 (excellent) for SHABD, 0.87 (excellent) for SHADD, 0.92 (excellent) for CBADD, and 0.89 (excellent) for IRABD.

Conclusions: Clinical measurements of passive GHJ range-of-motion analyzed in this study showed excellent or good intraobserver and interobserver variability. Our study showed that BPBP resulted in a multidirectional GH contracture in most patients. We have described a simple and reliable way to evaluate passive GH motion, providing reliable anatomic landmarks.

Keywords: Brachial plexus birth palsy; brachial plexus; glenohumeral angle; interobserver reliability; intraobserver reliability; shoulder contracture.

Publication types

  • Observational Study

MeSH terms

  • Adolescent
  • Birth Injuries / complications
  • Brachial Plexus Neuropathies / etiology
  • Brachial Plexus Neuropathies / physiopathology*
  • Child
  • Child, Preschool
  • Contracture / etiology
  • Contracture / physiopathology*
  • Female
  • Humans
  • Male
  • Observer Variation
  • Physical Examination / methods
  • Prospective Studies
  • Range of Motion, Articular*
  • Reproducibility of Results
  • Rotation
  • Shoulder Joint / physiopathology*