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

Background: Glenohumeral (GH) contractures appear in most patients with incomplete motor recovery as a result of progressive development of peritirticular 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 GIB 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), spinoliumeral adduction angle (SHADD), GH cross-body adduction (CBADD), and Gil internal rotation in abduction (IRABD). Anterior OH contracture was not evaluated. Results: Passive shoulder measurements obtained from the uninvolved and involved shoulders were as follows: SHABD, 42 degrees and 18 degrees, respectively; SHADD, 14 degrees and -1 degrees respectively; CBADD, 71 degrees and 41 degrees, respectively; and IRABD, 54 degrees and 37 degrees, 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. (C) 2018 Journal of Shoulder and Elbow Surgery Board of Trustees. All rights reserved.