|Medical Treatment||Initial Management|
Medical treatment of brachial plexus palsy includes diagnosis, ongoing assessment, and appropriate therapy.
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
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:
|Shoulder external rotators|
|Shoulder internal rotators|
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|
|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.
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.
Physical therapy is the only treatment necessary under these conditions: