Brachial Plexus Palsy Center

Medical Treatment       Initial Management
      Physical Therapy

Medical treatment of brachial plexus palsy includes diagnosis, ongoing assessment, and appropriate therapy.

Initial Management

Medical treatment of brachial plexus palsy begins with the following steps:


The infant's muscle strength and arm and hand movements are measured every month during the first 6 months. We use three grading systems to document muscle strength and functions of the upper extremities.

Motor Strength Assessment Scale
The Modified British Council Scale for muscle strength, illustrated below, is used for semiquantitative assessment of an infant's muscle strength.

1 - No or trace muscle contraction
2 - Muscle contraction without gravity
3 - Muscle contraction against gravity
4 - Muscle contraction against resistance
NG - Not graded due to difficulties

This muscle strength grading system is applied to each muscle group of the affected upper extremity, as shown below:

Muscle Strength
Shoulder external rotators  
Shoulder internal rotators  
Wrist flexors  
Wrist extensors  
Finger flexors  
Finger extensors  

Joint Movement Grading

This grading system allows for quantitative documentation of the joint movement.

Observation Central Grade Numerical Score
No joint movement 0 0
Flicker of movement 0+ 0.3
Less than half range 1- 0.6
Half range of movement 1 1.0
More than half range 1+ 1.3
Good but not full range 2- 1.6
Full range of movement 2+ 2.0

(Note: The best movement observed during evaluation is graded.)

This joint movement grading system is then applied to specific movements of each joint of the affected upper extremity, and a total numerical score is found.

Joint Movement Central Grade Numerical Score
Shoulder adduction    
Shoulder abduction    
Elbow flexion    
Elbow extension    
Wrist flexion    
Wrist extension    
Finger flexion    
Finger extension    
Total Numerical Score  

By recording these objective data for muscle strength and joint movement, a patient's progress can be followed through a series of examinations.

Mallet Scale

Another grading system to document functional changes of the shoulder and arm is the Mallet Scale, which is very useful in children older than two years. (Because it requires the cooperation of the patient, it is not suitable for younger children.) Click on the image to see a larger version.

Mallet Scale
Click for larger image

Physical Therapy

Physical therapy is the only treatment necessary under these conditions: