Brachial Plexus Injuries, Glenohumeral Subluxation, Neonatal Brachial Plexus Palsy
Conditions
Keywords
Alpha Angle, Shoulder Ultrasonography, Erb's Palsy, Glenohumeral Dysplasia, Humeral Head Displacement
Brief summary
This study will examine infants with a birth-related nerve injury called neonatal brachial plexus palsy, which can affect movement in the arm and sometimes cause the shoulder joint to shift out of its normal position (subluxation). Researchers will use ultrasound imaging to measure the shoulder joint and will compare these measurements with findings from a physical examination, to determine which clinical signs can help predict whether a baby's shoulder will develop this problem. The goal is to help doctors detect shoulder problems earlier, so that treatment can start sooner.
Detailed description
Infants aged 3 months to 1 year with neonatal brachial plexus injury (Narakas Group I-III) will be evaluated at a single pediatric rehabilitation clinic. At each visit, the same physiatrist will perform a standardized clinical examination, including assessment of demographic and obstetric history, subluxation-specific clinical signs (axillary skin fold asymmetry, palpable posterior fullness), passive range of motion, upper extremity length discrepancy, the Active Movement Scale, and the Toronto Test Score. A second physiatrist, blinded to clinical findings, will perform shoulder ultrasonographic evaluation using a posterior approach to measure the alpha angle and the percentage of humeral head displacement (PHHD). Glenohumeral subluxation will be defined as an alpha angle greater than 30 degrees; dislocation will be defined as an alpha angle greater than 30 degrees combined with PHHD greater than 50%. Associations between clinical findings and ultrasonographic subluxation will be analyzed using Generalized Linear Mixed Models to account for repeated measurements per patient, followed by ROC curve analysis to identify optimal predictive thresholds.
Interventions
DIAGNOSTIC_TESTShoulder Ultrasonography
Ultrasonographic measurement of the shoulder alpha angle and percentage of humeral head displacement (PHHD), to be performed at each clinical visit.
OTHERStandardized Clinical Examination
Standardized physical examination including passive range of motion, Active Movement Scale, Toronto Test Score, and subluxation-specific clinical signs, to be performed at each visit.
Sponsors
Fatih Sultan Mehmet Training and Research Hospital
Study design
Observational model
COHORT
Time perspective
PROSPECTIVE
Eligibility
Sex/Gender
ALL
Age
3 Months to 1 Years
Healthy volunteers
No
Inclusion criteria
* Diagnosis of neonatal brachial plexus injury (NBPI) between 3 months and 1 year of age * Narakas classification Group I, II, or III * Absence of nerve root avulsion
Exclusion criteria
* Prior shoulder surgery for NBPI * Inability to tolerate ultrasonographic examination * Concomitant musculoskeletal (e.g., torticollis, humeral fracture) or neurological disease * Bilateral NBPI * Narakas classification Group IV * Botulinum toxin injection to the affected shoulder
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Ultrasonographic Alpha Angle | Assessed at each clinical visit from 3 months to 1 year of age | Alpha angle will be measured sonographically at each shoulder examination. Glenohumeral subluxation will be defined as an alpha angle greater than 30 degrees. |
| Percentage of Humeral Head Displacement (PHHD) | Assessed at each clinical visit from 3 months to 1 year of age | PHHD will be measured sonographically at each shoulder examination. Glenohumeral dislocation will be defined as an alpha angle greater than 30 degrees combined with PHHD greater than 50%. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Passive Range of Motion of the Shoulder and Elbow | Assessed at each clinical visit from 3 months to 1 year of age | Passive range of motion of the shoulder (flexion, extension, abduction, internal and external rotation) and elbow (flexion, extension) will be measured using standard goniometry at each visit and evaluated for association with glenohumeral subluxation. |
| Active Movement Scale (AMS) Score | Assessed at each clinical visit from 3 months to 1 year of age | AMS score will be assessed at each visit as a clinical predictor of glenohumeral subluxation. |
| Toronto Test Score | Assessed at each clinical visit from 3 months to 1 year of age | Toronto Test Score will be calculated at each visit and evaluated for association with glenohumeral subluxation. |
| Subluxation-Specific Clinical Signs (Axillary Skin Fold Asymmetry and Palpable Posterior Fullness) | Assessed at each clinical visit from 3 months to 1 year of age | Presence of axillary skin fold asymmetry and palpable posterior shoulder fullness will be assessed at each visit and evaluated for association with glenohumeral subluxation. |
| Upper Extremity Length Discrepancy | Assessed at each clinical visit from 3 months to 1 year of age | Difference in upper extremity length between the affected and unaffected sides will be measured at each visit and evaluated for association with glenohumeral subluxation. |
| Reinnervation Status | Assessed at each clinical visit from 3 months to 1 year of age | Neurological reinnervation status (full, partial, or none) will be assessed at each visit relative to the prior visit. |
Countries
Turkey (Türkiye)
Contacts
CONTACTMelike Nur Rençber, MD
CONTACTEsra Giray, MD
Outcome results
None listed