Obstetric Brachial Plexus Palsy: The Mallet Grading System for Shoulder Function—Revisited

M M Al-Qattan,A A F El-Sayed

doi:10.1155/2014/398121

Abstract

The Mallet grading system is a commonly used functional scoring system to assess shoulder abduction/external rotation deficits in children with obstetric brachial plexus palsy. One feature of the Mallet score is that each grade is translated into certain degrees of deficiencies in both shoulder abduction and external rotation. The aim of the current study is to investigate the percentage of children in which the Mallet score could not be applied because of a discrepancy between the deficiency of shoulder abduction and shoulder external rotation. The study group included 50 consecutive unoperated older children (over 5 years of age) with Erb's palsy and deficits in shoulder movements. The Mallet score could be applied in 40 cases (80%). In the remaining 10 cases (20%), the Mallet score could not be applied either because shoulder abduction had a better grade than the grade of shoulder external rotation (n = 7) or vice versa (n = 3). It was concluded that documenting the deficits in shoulder abduction and external rotation are best done separately and this can be accomplished by using other grading systems.

Highlights

The most common secondary deformity in obstetric brachial plexus Erb’s palsy is seen at the shoulder; the most common shoulder deformity is the deficiency of shoulder abduction/external rotation [1].There are different methods of scoring shoulder abduction/external rotation of the shoulder such as the Toronto muscle grading system [2], the King Saud University grading system [3], and the Mallet grading system (Table 1)
The aim of this study is to investigate the percentage of children in which the Mallet score could not be applied to assess shoulder function in a series of unoperated older children with obstetric brachial plexus Erb’s palsy
In 10 cases (20%), the Mallet grading system could not be applied either because shoulder abduction had a better grade than the grade of shoulder external rotation (n = 7) or vice versa (n = 3)

Summary

Introduction

The most common secondary deformity in obstetric brachial plexus Erb’s palsy is seen at the shoulder; the most common shoulder deformity is the deficiency of shoulder abduction/external rotation [1].There are different methods of scoring shoulder abduction/external rotation of the shoulder such as the Toronto muscle grading system [2], the King Saud University grading system [3], and the Mallet grading system (Table 1). The most common secondary deformity in obstetric brachial plexus Erb’s palsy is seen at the shoulder; the most common shoulder deformity is the deficiency of shoulder abduction/external rotation [1]. One feature of the Mallet score is that each grade is translated into certain degrees of deficiencies in both shoulder abduction and external rotation. The authors noted that the Mallet score could not be applied to several children with obstetric ERb’s palsy mainly because there is a discrepancy in the Mallet grade of shoulder abduction and the grade of shoulder external rotation. The aim of this study is to investigate the percentage of children in which the Mallet score could not be applied to assess shoulder function in a series of unoperated older children (over 5 years of age) with obstetric brachial plexus Erb’s palsy. Older children were selected because the Mallet score requires special tasks that are difficult to apply to infants and younger children

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Conclusion