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Recent Advances in the Treatment of Brachial Plexu ...
Journal CME Article: Recent Advances in the Treatm ...
Journal CME Article: Recent Advances in the Treatment of Brachial Plexus Birth Injury Video 2
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Video Transcription
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.
Video Summary
The examination of the shoulder in brachial plexus birth palsy aims to assess active and passive shoulder motion, identify contractures, check for tenderness, and determine if the humeral head is subluxated posteriorly. The process involves observing the resting posture for internal rotation and flexion contractures, testing active abduction, and evaluating the reducibility of the humeral head. Important observations include changes in abduction contracture upon reduction and early scapular elevation. Tenderness is checked at the rotator cuff and glenohumeral articulation, with passive rotation assessed in different humeral head positions to gather insights on shoulder functionality.
Keywords
brachial plexus birth palsy
shoulder examination
humeral head subluxation
contractures assessment
rotator cuff tenderness
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