The goals of examination of the shoulder in the setting of brachial plexus birth palsy are to establish the active and passive arcs of motion at the shoulder in elevation and in rotation, establish the degree of internal rotation and abduction contractures in particular, test for tenderness, and for whether the humeral head is subluxated posteriorly. The examination would begin with the patient standing and facing, with the right shoulder and upper limb exposed, in order to observe the resting posture at the shoulder and elbow, which may reveal internal rotation at the shoulder and a flexion contracture at the elbow with an apparent pronation posture of the forearm. Posteriorly, the scapula may be small, elevated and rotated, which is not so apparent here. Active abduction can be tested in pure abduction and inflection. Whether the prominent posterior aspect of the humeral head is reducible with gentle external rotation or not is useful information. And whether the abduction contracture worsens after reduction is also relevant. One would test this by holding the humeral head reduced and rotating the scapula until the scapular spine is parallel to the floor to test for the thoracohumeral angle. Tenderness may be tested at the rotator cuff and the posterior glenohumeral articulation. And passive rotation may be examined with the humeral head subluxated and reduced. Whether the humeral head subluxates posteriorly further in internal rotation and inflection can be useful information. Note that the scapula elevates earlier during elevation of the humerus on the affected side, but substantial glenohumeral rotation is still present.

brachial plexus birth palsy

shoulder examination

humeral head subluxation

contractures assessment

rotator cuff tenderness