Obstetric Brachial Plexus Injury Research Articles

Lower trapezius transfer to infraspinatus in cases of sequelae of obstetric brachial plexus injury

Abstract Background Deficient shoulder function is a common and exhausting issue in children with obstetric brachial plexus injuries. Even with functioning elbow, wrist, and fingers, upper limb function is markedly disabled by limited shoulder abduction external rotation. Lower trapezius transfer carries many advantages; simple and safe technique, same line of pull as donor; reliable nerve supply (extraplexal from spinal accessory nerve), and not acting on rotation of the shoulder, mostly it will not adversely affect internal rotation range after the transfer. This study aims to evaluate the role of isolated lower trapezius transfer in reconstructing shoulder external rotation. Materials and methods This prospective case series study included 20 patients with sequelae of obstetric brachial plexus injury lacking shoulder external rotation who underwent lower trapezius transfer to infraspinatus. In all cases, the lower trapezius muscle was the donor, and the recipient tendon was the Infraspinatus muscle. Shoulder range of motion, Modified Gilbert grading, and Mallet Classification were used to evaluate results. Results The mean age at the time of surgery was 4.5 years. The average increase in shoulder external rotation and abduction was 40⁰ and 42.5⁰ respectively, the modified Gilbert grading improved from a mean of 3.85 to 4.85 postoperative. Mallet classification improved from a mean of 3.5 preoperative to 4.8 postoperative. Improvement (Mallet classification of ≥ 4) was obtained in 18 cases (90%). Conclusion Isolated lower trapezius transfer is considered an effective option with promising results in cases of sequelae of obstetric brachial plexus injury for restoration of shoulder external rotation as well as abduction.

Long-Term Outcomes of Obstetric Brachial Plexus Injury: A Single-Center Experience

Long-Term Outcomes of Obstetric Brachial Plexus Injury: A Single-Center Experience

Technique and Expected Benefit of Intraoperative Perfusion Imaging of Peripheral Nerves.

Peripheral nerve surgery, particularly in cases of nerve compression syndrome (NCS), necessitates a comprehensive evaluation of intraneural blood flow, as localized reductions in nerve perfusion are integral to the etiopathogenesis of such conditions. Although nerve perfusion is currently guided by morphologic characteristics, this assessment is subjective and prone to bias. Intraoperative fluorescence-assisted perfusion imaging with indocyanine green (ICG) is an established tool in flap and lymphatic surgery to objectively assess perfusion intraoperatively. However, only a few unspecific applications of ICG in peripheral nerve surgery have been published so far. In this study, we performed intraoperative perfusion imaging using ICG in 16 consecutive operations within the peripheral nervous system, including microsurgical reconstructions after obstetric brachial plexus injury, decompression for NCS, and vascularized ulnar nerve interposition transfers. Our findings show the utility of ICG in delineating healthy perfusion borders at proximal and distal stump levels after neuroma resection, and we demonstrate a correlation between histological findings and these clinically observed perfusion patterns. In NCS cases, we demonstrate that ICG imaging is effective in highlighting reduced perfusion predecompression and improved perfusion postdecompression. Additionally, ICG proved valuable for assessing perfusion of free vascularized nerve grafts. Intraoperative ICG perfusion imaging is a valuable tool during surgery of the peripheral nervous system, providing insights into the etiopathogenesis of NCS and aiding in the visualization of perfusion. This study underscores the potential of ICG in nerve surgery and its applicability for improving surgical outcomes and advancing our understanding of peripheral nerve pathologies.

Two-Stage Glenohumeral Fusion for the Paralytic Shoulder

BackgroundShoulder fusion after nerve injury can improve overall arm function, however high revision and low patient satisfaction rates have been described. The purpose of this study is to describe a two-stage shoulder fusion, first pinning in a position of function and then converting to a shoulder fusion. Our hypothesis is that temporary pinning improves overall satisfaction after shoulder fusion in comparison to satisfaction reported in the literature. MethodsA retrospective review was performed for patients receiving two-stage shoulder fusion between 2020 and 2023. Patient demographics and clinical outcomes were recorded. Univariate statistics were performed to compare pre- and postoperative values. ResultsEighteen patients with an average age of 47 +/- 17.3 years and average follow-up of 23.7 +/- 4.5 months were included. Preoperative diagnoses included brachial plexus injury (n=13; 72%), late presentation obstetric brachial plexus injury (n=2; 11%), traumatic brain injury (n=1; 14.2%), cervical spinal cord injury (n=1; 14.2%) and iatrogenic axillary nerve injury with advanced arthritis (n=1;14.2%). Twelve (67%) patients received unilateral shoulder fusion 2.7 +/- 1.9 days after their initial pinning. Six patients (28.6%) did not receive a second stage fusion. Reasons for not continuing with fusion were attributed to perceived hand function and arm position. Three patients received two shoulder pinnings prior to their fusion to adjust the fusion position to accommodate more internal rotation. After fusion, both SSV (5.2 +/- 5.5% versus 71.6 +/- 10.4%; p<0.001) and pain (2.3 ± 4.0 vs 0.5 ± 0.71; p=0.56) improved. Forward elevation (5 +/- 12 versus 108 +/-35; p=0.01), abduction (10 +/- 15 versus 78 +/-9; p<0.001)), and external rotation (5 +/- 12 versus 22 +/- 17; p=0.26) all improved postoperatively while internal rotation remained limited (1.3 +/- 0.9 versus 1.2 +/- 0.5; p=0.84). Time to union was 15.4 +/- 15.4 weeks confirmed with CT scan. There was one (5.5%) reoperation for non-union, and patient satisfaction was 92% (n=11/12). ConclusionShoulder fusion after neurologic injury provides improved function and patient outcomes, however some patients may be unsatisfied with their new arm position. Percutaneous pinning prior to fusion is tolerated and allows patients to trial potential fusion positions. This method may improve patient satisfaction and avoid excess morbidity in those that would not be satisfied with a shoulder fusion.

Early Conservative Physical Therapy Management of Babies With Obstetric Brachial Plexus Injury to Facilitate Spontaneous Recovery.

To evaluate the effect of early immobilization and proper handling techniques in infants with Obstetric Brachial Plexus Injury (OBPI) in the first 2weeks of life. Six 1-day-old infants (2 males and 4 females) with OBPI were included. The assessments were done at baseline, post-intervention, and 3-month follow-up, which involved a physical exam, Narakas classification, Active Movement Scale, and gross and fine motor skills evaluation. All infants had upper Erb's palsy. They had statistically significant improvement in the Active Movement Scale scores post-intervention with a large effect size. These improvements were maintained at follow-up. All infants achieved age-appropriate gross and fine motor skills with the affected upper limb at 3months of age. Early conservative physical therapy management had a statistically significant effect on enhancing spontaneous recovery and preventing further nerve injury in OBPI infants.

Robotic microsurgery for pediatric peripheral nerve surgery

The technology of microsurgical robotic systems has shown potential benefit during the last decade for a variety of microsurgical procedures, such as vascular anastomoses, lymphatic anastomoses or nerve coaptation. At the same time, peripheral nerve surgery has produced ever more sophisticated nerve transfers in which the smallest nerve structures are connected to each other. Following obstetric brachial plexus injuries, nerve reconstruction surgery is often required in the first few years of life in order to improve the function of the affected arm, including nerve transfers to denervated muscles, which enable reinnervation of target muscles. In pediatric patients, these donor-nerve structures are even smaller than in adults, which further increases the demands to the microsurgeon. In this publication, we show the possible applications, capabilities and limitations of a dedicated microsurgical robotic system for nerve transfers in pediatric patients.

"Voiceless Pain"-Assessment of Pain in Patients with Obstetric Brachial Plexus Injuries: A Retrospective, Single Center Analysis.

Obstetric brachial plexus injuries (OBPIs) not only lead to severe and life changing sequelae regarding motor impairment but can also be responsible for multi-characteristic pain. In everyday routine, questions regarding pain of the developing child with an OBPI are often overseen and neglected. We aimed to elucidate this specific question and analyzed all patients with OBPI treated in our center to unmask initially non-observed pain and ultimately put pain in correlation to the surgical reconstructive treatment performed. This single center retrospective study analyzes patients with OBPI treated in our center over the past 20 years. Patients were surveyed by the adolescent pediatric pain tool assessment to evaluate pain over their entire life span by excluding potential postoperative pain episodes. A total of 95 patients were initially contacted of which 78 returned the questionnaire (53.8% female, 46.2% male). In our patient cohort, the vast majority constituting 84.6 percent did not experience pain in the affected upper extremity over the years up to the date of their examination. Most of the patients describing pain had not been microsurgically treated for brachial plexus reconstruction in their neonate period. Merely, 33.3 percent of all OBPI experiencing pain had been microsurgically reconstructed at a median age of 7 months. Pain interrogation in patients with OBPI is often overseen during daily clinical routine. Adequate age-appropriate analgesic therapy regimens adapted to the individual are highly recommended. Timely microsurgical brachial plexus reconstruction may result in reduced lifetime pain experiences.

Assessment of Triangle Tilt Surgery in Treatment of Obstetric Brachial Plexus Injury

Assessment of Triangle Tilt Surgery in Treatment of Obstetric Brachial Plexus Injury

Prominent themes in shoulder dystocia research: A bibliometric and document-based analysis.

This study aims to comprehensively examine the academic development of shoulder dystocia (SD) through bibliometric and document analysis and to identify topics that can guide future research. In this study, performance, co-citation, co-word, and document analyses were used as bibliometric analysis techniques. The study identified 3 main themes in terms of the intellectual structure of Shoulder Dystocia (SD): "Management of SD, Risk Factors and Associated Complications," "Clinical Practices, Birth Abnormalities and Effects of Complications," and "Impact of Education, Clinical Maneuvers and Fetal Health Outcomes." Co-occurrence analysis identified 4 significant themes: "Management and Clinical Practice of SD," "Fetal Macrosomia and Risk Factors," "Obstetric Maneuvers and Brachial Plexus Injury," and "Clinical Trends and Risks in SD." Additionally, ten consolidated themes were identified as a result of thematic coding analysis. Shoulder dystocia remains a critical component of obstetric practice. Themes such as training and simulation, risk factors, and technical and management approaches are consistently emphasized. Technological advances and studies on how machine learning techniques can be used effectively in this field reflect innovative approaches in the scientific literature. This analysis confirms that shoulder dystocia is a complex topic requiring a multidisciplinary approach and that research in this field is constantly evolving.

Surgical Repair of Obstetric Brachial Plexus Injuries: A Case Series and Discussion of the Current Literature

ObjectiveTo assess factors which may influence surgical success following brachial plexus reconstruction for Obstetric Brachial Plexus Injury (OBPI). MethodsWe retrospectively reviewed the charts of 27 consecutive patients who underwent brachial plexus reconstruction following OBPI by a single pediatric neurosurgeon, 22 of which had adequate follow-up be included in analysis. Data on pre-operative function, intra-operative findings, and post-operative outcomes were collected. Mallet grades for abduction, external rotation, and hand-to-mouth were used as a measure of upper trunk function. ResultsAll patients undergoing brachial plexus reconstruction (n=27) were found to have some degree of upper-trunk injury intra-operatively. Of the 22 patients with adequate follow-up to be included in the analysis, 17 had some degree of improvement in Mallet grade post-operatively. Prior to surgery, 95% (21/22) of patients had an abduction Mallet grade of 1, compared to 23% (5/22) at the time of maximum improvement (p<0.001). These values were 100% (20/20) to 35% (5/14) (p<0.001), and 95% (21/22) to 27% (6/22) (p<0.001) for external rotation and hand-to-mouth, respectively. The average time to maximum Mallet grade was 583 days (SD 356 days). Age at time of surgery and time to maximum recovery were not found to be correlated. ConclusionBrachial plexus reconstruction is an effective treatment modality for patients without spontaneous recovery of upper extremity function following OBPI, although identifying the optimal age-range for surgery remains elusive. Patients with intraoperative findings consistent with a more severe injury may be less likely to benefit from surgery.

Peripheral nerve decompression for pain relief in the setting of previous obstetrical brachial plexus injury: a retrospective case series.

In children with previous obstetrical brachial plexus injury (OBPI), upper extremity pain is present in 45 to 66% of patients. Recent literature reports this as musculoskeletal or neuropathic in nature. The purpose of the study is to demonstrate that peripheral nerve decompression, and neurolysis may be an effective treatment for patients with upper extremity pain in the context of previous OBPI. A retrospective chart review was performed on patients undergoing peripheral nerve decompression and neurolysis after OBPI by senior author. The primary outcome assessed was pain, and secondary outcome measure was range of motion of the wrist and elbow. Outcome measures were assessed preoperatively as well as at their subsequent follow-up. Six patients were included, with a mean age of 14years old at time of decompression. Three patients underwent median nerve, two patients underwent ulnar nerve, and one patient underwent posterior interosseous nerve decompression. There was a substantial improvement in pain post-operatively, demonstrated by reduction or resolution of subjective pain in all patients and resolution of Tinel's sign. There was a modest improvement in range of motion. This study demonstrates an improvement in subjective pain and range of motion after decompression and neurolysis in small subset of OBPI patients. It generates the hypothesis that peripheral nerve compression is a source of pain that can be addressed in this population. Future research should focus on confirming this hypothesis and assessing treatment options on a larger scale.

Changing handedness after nerve reconstruction in brachial plexus birth palsy.

Right obstetric brachial plexus injuries (OBPI) often lead to left-handedness before limb function is restored post-surgery. A pertinent question arises about promoting a transition from left to right-handedness. We hypothesized that, with the decrease in neuroplasticity, handedness switching is not only difficult, but also reduces handedness-speech lateralization, impaired motor adaptability, and compromised language proficiency. We retrospectively analyzed clinical data from January 1996 to January 2012 at our hospital. Participants were divided into intervention or control groups based on handedness switching. We compared handedness and computed lateral quotient (LQ) and lateralization index (LI) for handedness-speech center. Additionally, we assessed dominant hand's writing speed, language function, and IQ. Associations between absolute LI and LQ values, writing speed, language scores, and IQ were examined. Nineteen extended Erb's palsy participants were enrolled, eight in the intervention group, and 11 in the control. No right-handed individuals were found in either cohort. The intervention group had significantly lower LQ and LI values, and fewer achieved normal writing speed. Yet, no notable disparities in language scores or IQ emerged. Notably, we established correlations between motor finesse, handedness degree, and handedness-speech lateralization. For right extended Erb's palsy, shifting handedness is nearly unfeasible, and such an endeavor could trigger a reduction in handedness-speech lateralization magnitude and diminished motor finesse.

Comprehensive Therapeutic Approach for Obstetric Brachial Plexus Injuries: A Scoping Review

Introduction: About 1.4 out of 1000 deliveries of live babies result in Obstetric Brachial Plexus Injury (OBPI), which is characterised by flaccid paralysis of the arm due to brachial plexus damage to the nerve following birth. Shoulder dystocia, maternal hyperglycemia, instrumental delivery, and breech delivery are the primary risk factors. Repercussions are seen in the form of muscle weakness, and activity limitations. Thus, early intervention is a necessity here. Aim: To highlight all the therapeutic interventions that are exercised in children with brachial plexus injury. Materials and Methods: To retrieve literature about obstetric brachial plexus injury, the Cochrane Library and PubMed databases were accessed for this scoping review. A total of 256 articles were determined to be pertinent to the investigation. In summary, 40 met the review’s inclusion specifications, so they had been thoroughly reviewed. Results: There is unanimous agreement that principles of Modified Constraint-induced Movement Therapy is the main treatment option for the rehabilitation of OBPI. The disparities have been identified and the need for further research has been highlighted. Conclusion: The present study concludes that Modified constraint-induced Movement Therapy (mCIMT) has found to be effective for upper limb function and strength in cases of OBPI. However, efficacy of other techniques like Kinesio-taping and dynamic orthosis in combination with mCIMT needs more clarity, in terms of literatures and evidences. Also, emerging source of virtual rehabilitation in terms of Erb’s Palsy requires justifications. Implication: The present scoping review provides an insight of all the techniques which shall be administered while treating cases of OBPI in clinical practice.

Reverse shoulder arthroplasty in obstetric brachial plexus injury: our experience with shoulder motion analysis

BackgroundObstetric brachial plexus injury (OBPI) is a weakening or paralysis of the upper arm caused by brachial plexus injury followed by a muscle paralysis with severe repercussions on the movement of the shoulder joint following a progressive glenohumeral joint deformity.This case series analyzes the clinical and radiological outcomes of reverse total shoulder arthroplasty (RSA) in OBPI patients with a follow-up of 2 years.Materials and methodsOBPI patients with secondary end-stage glenohumeral arthritis were enrolled in the study and they were treated with RSA. Patient demographics and clinical outcomes [Range of Motion (ROM), Visual Analog Scale (VAS), Oxford Shoulder Score (OSS)] were evaluated. A novel Shoulder motion analysis was carried out to investigate specific movement patterns of scapulothoracic movements in these patients. This study is a prospective cohort study.ResultsFour Patients (M: F = 1:3) were enrolled in the study, the mean age was 49.3 years (+ 2.75), the mean OSS (Oxford Shoulder Score) decreased from 48.8 (± 2.5) preoperatively to 18.30 (± 2.78), the mean VAS (Visual Analog Scale) decreased from 7.25 (± 0.5) to 1.7 (± 0.3) in the follow up (∆% relative pain reduction:− 76.5%), Shoulder ROM obtained an improvement (p < 0.05) except for abduction and external rotation. The average follow-up time was 26.3 months (+− 4.5). Shoulder motion analysis showed a complete loss of the scapular tilting above 90 degrees of flexion compared to the typical one of standard RSA with a pattern shifted towards scapular retraction (engaging trapezius and rhomboid muscles) to compensate the loss of the posterior tilting.ConclusionsRSA in OBPI patients demonstrated a significant improvement of pain symptoms and a moderate improvement in daily activities, anyway with a more appreciable quality of life over time even if the marked hypotrophy especially of the posterior shoulder muscles showed some limits in maintaining suspension of the upper limb and a minor external rotation, with an internal rotation attitude during the movements.Level of evidence: Level IV, Case series.

Is it possible to follow the risk of rupture after end-to-end nerve repairs in brachial plexus surgery? Technical note.

In traumatic and obstetric brachial plexus injuries, removal of the damaged nerve, repair with the nerve grafts, and nerve transfers are mostly preferred techniques. Success is directly proportional to surgical technique as it is known that end-to-end repair of the peripheral nerves gives better results. The greatest risk in end-to-end repair is the nerve rupture at the brachial plexus repair region and this cannot be detected by conventional radiological techniques. Brachial plexus injuries of obstetrical and traumatic patients were operated. If possible and at least one nerve was repaired end to end, follow-up of nerve continuity was done by titanium hemopclip insertion to both sides of the nerve repair area. A new technique nerve repair site marking was developed and end-to-end nerve repair continuity was followed simply by x-ray. This technique was used for end-to-end nerve coaptions of 38 obstetric and 40 traumatic brachial plexus injuries. Follow-up was done for 6 weeks. Every week patients sent the x-ray of the repair site. Only 3 patients had nerve repair site rupture, and revision surgery was done immediately. Nerve repair site marking technique and follow-up with only x-ray is a simple reliable, safe, and cheap method that can be applied to any end-to-end nerve repair. This technique has no morbidity or side effects. The aim of the study is to summarize or explain the nerve repair site marking technique used in the brachial plexus region.

Role of computed tomography in glenohumeral joint deformity following obstetric brachial plexus injury: Proposed radiological classification

Objective: The study aimed to study the usefulness of computed tomography (CT) in the measurement of glenoid version angle, humeral head dislocation, or subluxation and to propose a grading system for the severity of glenohumeral deformity following OBPI. Material and Methods: A prospective study conducted over a period of 3 years. The study group includes 21 children below the age of 12 years presenting with posterior dislocation of the shoulder, with prior history of OBPI. CT of both shoulders was done using a 128-slice CT scanner. The children were assessed clinically by a Modified Mallet Scale and graded by Waters classification. Results: We graded the severity of deformity on the affected side according to Waters et al. The difference between affected and normal shoulder glenoscapular angle (GSA), percentage of humeral head anterior to the scapular line (PHH), scapular height, and scapular width was statistically significant (P &lt; 0.05). We propose grading for severity and assessed joint stability based on the CT parameters. GSA and PHH show a statistically significant difference between the three grades (P &lt; 0.05). We also confirm that the higher the grade of the deformity, the more difficult the shoulder movements leading to worse scores on the Modified Mallet Scale. Conclusion: CT scan identifies glenohumeral deformities such as increased glenoid retroversion, posterior dislocation of the humeral head, smaller humeral head size, and smaller size of the scapula as deviations from normal status and helps in radiological grading.

A physiological signal database of children with different special needs for stress recognition

This study presents a new dataset AKTIVES for evaluating the methods for stress detection and game reaction using physiological signals. We collected data from 25 children with obstetric brachial plexus injury, dyslexia, and intellectual disabilities, and typically developed children during game therapy. A wristband was used to record physiological data (blood volume pulse (BVP), electrodermal activity (EDA), and skin temperature (ST)). Furthermore, the facial expressions of children were recorded. Three experts watched the children’s videos, and physiological data is labeled “Stress/No Stress” and “Reaction/No Reaction”, according to the videos. The technical validation supported high-quality signals and showed consistency between the experts.

The Mental Health Implications of Obstetric Brachial Plexus Injuries (OBPI) on Parents.

Obstetric brachial plexus injuries (OBPI) can have mental health implications on parents coping with this injury to their newborn. The purpose of this study was to assess the mental health of mothers with newborns with an OBPI and identify resources that can help screen and treat mental health needs. Three groups of mothers were prospectively given a self-reported survey: 1) Newborns with OBPI; 2) Newborns in the nursery without OBPI; 3) Newborns in the neonatal intensive care unit (NICU). The survey consisted of demographic questions, the PHQ-9 and PCL-S screening tools, and parents' exposure to community violence, family support and use of drugs or alcohol. Fifty-seven mothers were prospectively enrolled, and 30% (17/57) of mothers screened in for post-traumatic stress disorder (PTSD). OBPI mothers had significantly higher rates of PTSD symptoms when compared to mothers of children in the full-term nursery (difference = 36.4%; p < 0.01). No statistically significant difference was found between groups regarding depression symptoms. OBPI can be very difficult to cope with for parents and family members. Forty-two percent of mothers with newborns with OBPI or children in the NICU screened in for PTSD symptoms. OBPI clinics should be staffed similarly to the NICU with clinical social workers to appropriately screen and treat parents with PTSD and depression symptoms.

A systematic review of brachial plexus injuries after caesarean birth: challenging delivery?

BackgroundCaesarean section (CS) is widely perceived as protective against obstetric brachial plexus injury (BPI), but few studies acknowledge the factors associated with such injury. The objectives of this study were therefore to aggregate cases of BPI after CS, and to illuminate risk factors for BPI.MethodsPubmed Central, EMBASE and MEDLINE databases were searched using free text: (“brachial plexus injury” or “brachial plexus injuries” or “brachial plexus palsy” or “brachial plexus palsies” or “Erb’s palsy” or “Erb’s palsies” or “brachial plexus birth injury” or “brachial plexus birth palsy”) and (“caesarean” or “cesarean” or “Zavanelli” or “cesarian” or “caesarian” or “shoulder dystocia”). Studies with clinical details of BPI after CS were included. Studies were assessed using the National Institutes for Healthy Study Quality Assessment Tool for Case Series, Cohort and Case-Control Studies.Main results39 studies were eligible. 299 infants sustained BPI after CS. 53% of cases with BPI after CS had risk factors for likely challenging handling/manipulation of the fetus prior to delivery, in the presence of considerable maternal or fetal concerns, and/or in the presence of poor access due to obesity or adhesions.ConclusionsIn the presence of factors that would predispose to a challenging delivery, it is difficult to justify that BPI could occur due to in-utero, antepartum events alone. Surgeons should exercise care when operating on women with these risk factors.

Efficacy of Kinesio® tapes in obstetrical brachial plexus injury: a randomized controlled trial

ObjectivesThe purpose of this study was to investigate the effectiveness of Kinesio® tape application associated to exercise in patients with obstetric brachial plexus injury (OBPI). Materials and methodsNinety patients with Erb-Duchenne palsy secondary to OBPI participated in a 3-month study, in 2 groups; study group (n = 50) and control group (n = 40). Both followed the same physical therapy program, while the study group also received Kinesio® taping over the scapula and forearm. The patients were evaluated, pre- and post-treatment, using the Modified Mallet Classification (MMC), Active Movement Scale (AMS), and active range of motion (ROM) of the plegic side. ResultsThere were no statistically significant intergroup differences in age, gender, birth weight or plegic side (p > 0.05), or in pre-treatment MMC and AMS scores (p > 0.05). There were significant differences in favor of the study group for Mallet 2 (external rotation) (p = 0.012), Mallet 3 (hand on the back of the neck) (p < 0.001), Mallet 4 (hand on the back) (p = 0.001) and total Mallet score (p = 0.025), and for AMS shoulder flexion (p = 0.004) and elbow flexion (p < 0.001). ROM results before and after treatment (within groups) showed significant improvement in both groups (p < 0.001). ConclusionSince this a was a preliminary study, the results should be interpreted with caution in terms of clinical efficacy. The results suggest that associating Kinesio® taping to conventional treatment helps functional development in patients with OBPI.’