Treatment of a brachial plexus injury using kinesiotape and exercise.

PURPOSE: This describes a child whose neonatal brachial plexus injury was treated with kinesiotape and exercise.

DESCRIPTION: The subject was a two-year-old female whose X-rays demonstrated severe inferior subluxation of the humeral head and winging of the scapula on the left. She was fitted with a shoulder brace with surgery scheduled in six months. The initial PT exam noted 80 degrees of shoulder abduction (trumpet sign), significant asymmetry, and nonuse. Mallet score was 15/25. Treatment consisted of d/c of the brace and E-stimulation, parent education on exercise and taping, and kinesiotape to facilitate rotator cuff and scapular stabilizers. Typical wear time was 2-3 days on, 1-2 days off.

OUTCOMES: After 2 weeks, there was prominent deltoid definition. The shoulder was in 20 degrees of abduction, shoulders level with less scapular winging. Scapular stabilizers were then taped. At 4 weeks, her arm was held to her side displaying a stable symmetrical scapula. The arm displayed increased fine motor use and initiation of activities. At 10 weeks there was a forced d/c, and a decline toward baseline levels. After 2 weeks of reinstatement, function returned to prior level. At 20 weeks (12 total visits) she displayed full ROM, symmetrical shoulders, Mallet score of 20/25, rare trumpet sign, and was hanging by arms during play. X-rays displayed significant improvement in humeral head position, rib cage rotation, angle of scapula and clavicle, and size and mineralization of humerus. Reconstructive surgery was cancelled.

DISCUSSION: Kinesiotape and parent education made a significant difference in this child's function.