Physiotherapy Following

Brachial Plexus Birth

Palsy
(BPBP)
N.SARANYA. PT

Dr. S.RAJA SABAPATHY,

MS M Ch DNB FRCS

Department of hand therapy

GANGA HOSPITAL
COIMBATORE.

Birth Palsy
It is a low velocity injury
Partial injuries to the roots are
common
When fully ruptured, the distance
between the roots to be bridged is not
much and some regeneration is
possible
Useful
function of the affected muscles will return
in most cases

Problem : Co Contractions
Adductors with
Abductors
Internal Rotators
with External
Rotators
Elbow Flexors with
Abductors of shoulder

 The other problem: Recovery of

one group of muscles earlier and
better then its antagonist muscle
Unopposed action of this group
causes contractures
All this is super imposed on growth

Primary
Effects

Secondary
Effects

Tertiary
Effects

Classical Deformity

Role of Physiotherapist

Pre operative
Immediate post
operative
Long term follow up

Aim of Physiotherapy

To Maintain Joint Range of Motion

To Prevent Deformities
To obtain an optimal Functional
Outcome After Surgical Intervention
Sensory re-education
Splinting
Parent / Patient satisfaction
Enhance ADL

Assessment

Personal history
Previous history
of treatment
Clinical
1. Modified
Mallet
score
2. Strength
3. Sensory
4. stereo gnosis
5. Motor grading
6. ROM

Proforma

Early
Physiothera
py

Surgical Options
Horizontal
Bone

Vertical

Muscle

Postoperative
Physiotherapy
Passive movements of distal joints

Shoulder external and internal

rotation exercises
Active assisted shoulder abduction
Stretching of shoulder abductors
Strengthening of shoulder abductors

Home program
1. Overhead pulley exercises
2. Picking up of objects and placing over
head
3. Finger ladder exercises
4. Wand exercises promoting shoulder
abduction
5. To encourage eating, bathing, buttoning
6. Swimming the best exercise.

Statue of Liberty Splint

Age - 2y 1m

Preoperative

Postoperative 1 y

Age - 1 yr 4m

Preoperative

Postoperative 4 m

Results
Preoperative average abduction- 81degrees
(Range:20-150 degrees)
Postoperative average abduction- 144degrees
(Range: 80-180 degrees)
Increase in abduction range-63degrees (Range:20110 degrees)

Results
Mallet score
improves by an
average of 2.5
points
Overall symmetry
of the
movements at
limb in improved

What can not be

expected
Total correction of Internal Rotation
Deformity at the Shoulder

SHEAR Deformity
Scapula Hypoplasia Elevation And Rotation
Nath RK, Lyons AB, Melcher SE, Paizi M. Surgical correction of the medial rotation
contracture in obstetric brachial plexus palsy. J Bone Joint Surg 2007, 89B: 1638-44.

Triangular Tilt Operation

1. Osteotomy of the clavicle (middle
third and distal third junction )
2. Osteotomy of the acromion at the
site where it narrows.
3. Shaving of the protruding medial
border of the scapula.
4. Anterior capsular release/ Posterior
capsuloraphy

Immobilization

Post op Physiotherapy
1st week
Maintain the splint all
the time remove only
during exercises and
gentle cleaning
Gravity eliminated
rotation of the shoulder
joint
Elbow bending and
straightening
Hand mobilization

2nd week
Maintain the splint all the time remove
only during exercises and gentle
cleaning
Continue all exercise in 1st week
ADD: Gentle passive shoulder abduction
to 120degree

3rd week

Maintain the splint all the time remove

only during exercises and gentle
cleaning
Adduction of arm
Gentle passive shoulder abduction to
140degree
Active abduction as much as tolerated
Active and passive external rotation by
keeping arm side of body and elbow
flexed to 90degree
Elbow and hand mobilization

4th week
Passive shoulder abduction to
180degrees
Active shoulder abduction as much as
possible, increase range every day.
Passive external rotation of shoulder by
keeping the arm by side of chest and
elbow fixed to its full range
Encourage active external rotation as
much as possible.

After 4 weeks
During day time remove the splint for
few hours
Start with 2hrs/day during 5th week;
5hrs/day during 6th week, 8hrs/day in
7th week and 12 hrs in 8th week.
Continue all exercises
Exercise can be made more
aggressive.

After 8 weeks
No splint required during day
Night splint to be continued for 6
months
More aggressive physiotherapy.

Triangular Tilt Results

Pre op

Post op

Triangular Tilt Results

Pre op

Post op

Pre-op

Post-op

Mallet score

Mallet score
improves by an
average of 2.5
points

THANKYOU
FOR YOUR
TIME & PATIEN
CE