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Active Movement Scale Scores Impact Surgical Decision Making in Perinatal Brachial Plexus Palsy
Anne E. Glenney, BA; Meeti Mehta, BS; Alexander Comerci, BS; Hilary Liu, BS; Elizabeth A. Moroni MD MHA; Yusuf Surucu, MD; Kacey Marra, PhD; Alexander J. Davit, MD
UPMC
2023-01-31
Presenter: Anne E. Glenney
Affidavit:
Vu Nguyen
Director Name: Vu Nguyen
Author Category: Medical Student
Presentation Category: Clinical
Abstract Category: Hand
Introduction: Perinatal brachial plexus palsy (PBPP) poses significant challenges to treating providers. Evaluating upper-extremity motor power in infants is difficult, and it is unclear which patients will improve and which will require surgery. Our study utilizes the Active Movement Scale (AMS) to describe trends in motor strength over time to understand the relationships between AMS scores, management and outcomes in PBPP.
Methods: A retrospective review of patients with PBPP presenting to our institution between 2008 and 2020 was conducted. Variables included demographics, birth history, presence of risk factors, AMS scores, management, and outcomes. Inclusion criteria mandated a minimum of three AMS scores.
Results: 173 PBPP patients presented during the study time-period; 57 met inclusion criteria and 17 required surgery. The average AMS score at initial presentation for non-surgical patients was 85.0, compared to 41.3 in surgical patients (p<0.001). Non-surgical patients demonstrated significant improvement in AMS to an average of 101.6 (p<0.001) at follow up (on average, at 17 months old). While there were absolute differences in AMS scores between groups, there was no difference in the rate of improvement of AMS scores between non-operative and operative patients pre-operatively (p=0.287). Following surgery, patients' AMS scores increased significantly to an average of 74.6 (p<0.001). Notably, each one-point increase in initial AMS score was associated with a 9.88% reduction in likelihood of surgery (p=0.004).
Conclusion: AMS score at time of presentation may predict the likelihood of requiring surgery; however, there was no difference in pre-operative rate of improvement between groups.
