Functional Elbow Range of Motion in Children and Adolescents

Abstract

Royalty: Lippincott, Williams, & Wilkins (Bae) Other: Orthopediatrics: Clinical Education Advisory Board (Bae) In adults, it has been shown that contemporary tasks require greater elbow flexion and pronation than standard functional tasks.1 Whether this is true in children is not established. We hypothesize that to perform functional and contemporary tasks, children and adolescents require a greater range of elbow motion and forearm rotation as compared with those reported for adults.2 Nineteen subjects performed 10 functional tasks and 4 contemporary tasks (Table 37-1). Kinematic data were captured using a 3D motion analysis system as previously described.3 Mean, standard deviation, and confidence intervals were collected for elbow flexion, extension, pronation, and supination. Paired t-tests were performed to compare elbow kinematics of children (6–11 years old) with those of adolescents (12–16 years old), with a significance criterion of P < .05. An a priori power analysis suggested that 7 subjects in each group were needed to determine a difference of 5° between the child and adolescent groups (power 80%, alpha 0.05). Ten children and 9 adolescents were tested. The mean arc of motion to achieve functional tasks was 34° to 124° of elbow extension/flexion, and 30° to 33° of supination/pronation. Contemporary tasks required 51° to 109° of elbow extension/flexion and 18° to 55° of supination/pronation. A greater pronation/supination arc (107°) and a greater amount of elbow flexion (148°) were required to bring a cellular phone to the ear. A greater amount of pronation (65°) was required to type on a keyboard. No significant differences were noted between the mean arc of motion for children and adolescents. To complete all functional and contemporary tasks, subjects used, on average, an 11° to 148° arc of flexion/extension and a 2° to 65° arc of supination to pronation. •Pediatric subjects achieve functional tasks with a smaller arc of motion than that previously reported for adults.•Compared with functional tasks, however, children and adolescents require a larger arc of motion in elbow flexion/extension and forearm pronosupination to achieve specific contemporary tasks such as keyboarding and cell phone use.•The often-quoted standard of an elbow flexion arc of 30° to 130° with 50° pronation and 50° supination2 would not allow a child to perform several tasks, including cell phone use, placing the hand on top of the head, and keyboarding.•Awareness of a greater need for elbow motion to achieve tasks including cell phone and computer use may guide surgeons in the care of posttraumatic and congenital elbow and forearm conditions in children.Table 37-1Functional and contemporary tasks performed by subjects.Functional TasksContemporary TasksFull elbow flexion to full extensionTyping on a keyboard (seated)Full wrist pronation to full supinationUsing a computer mouse (seated)Hand to top of headUse cell phone to answer callHand to back of headUse cell phone to textHand to mouthHand to backReading a magazine (seated)Eating with a fork (seated)Drinking from a glass (seated)Standing up from a chair Open table in a new tab