{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,18]],"date-time":"2026-03-18T04:45:22Z","timestamp":1773809122514,"version":"3.50.1"},"reference-count":30,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,3,17]],"date-time":"2026-03-17T00:00:00Z","timestamp":1773705600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"},{"start":{"date-parts":[[2026,3,17]],"date-time":"2026-03-17T00:00:00Z","timestamp":1773705600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Develop Med Child Neuro"],"abstract":"Abstract<\/jats:title>\n \n Aim<\/jats:title>\n To examine the relationship between active shoulder external rotation recovery and passive glenohumeral mobility in children with upper\u2010trunk brachial plexus birth injury (BPBI) after nerve surgery.<\/jats:p>\n <\/jats:sec>\n \n Method<\/jats:title>\n This retrospective analysis included children with upper\u2010trunk BPBI who underwent primary surgery of the C5 and\/or C6 spinal nerves with 2 or more years of follow\u2010up. Linear mixed models were used to analyse passive and active external rotation in adduction at ages 1, 3, 5, 7, and 15\u2009years, adjusted for diagnosis and suprascapular nerve reconstruction strategy (grafting, transfer, neurolysis).<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n We included 322 children (142 males and 180 females), with a mean (SD) follow\u2010up of 7\u2009years 7\u2009months\u00a0(4\u2009years 7\u2009months); median age at surgery was 5\u2009months (interquartile range\u00a0=\u00a04\u20136\u2009months). Active external rotation increased on average by 2.1\u00b0 per year (95% confidence interval [CI]\u00a0=\u00a01.4\u00b0 to 2.8\u00b0,\n p<\/jats:italic>\n \u2009<\u20090.001), while passive external rotation decreased on average by 2.6\u00b0 per year (95% CI\u00a0=\u00a02.2\u00b0 to 3.0\u00b0,\n p<\/jats:italic>\n \u2009<\u20090.001). Passive external rotation was on average 65\u00b0 (95% CI\u00a0=\u00a062\u00b0 to 68\u00b0,\n p<\/jats:italic>\n \u2009<\u20090.001) greater than active external rotation. The difference decreased by 4.5\u00b0 per year (95% CI\u00a0=\u00a03.8\u00b0 to 5.2\u00b0,\n p<\/jats:italic>\n \u2009<\u20090.001). At age 15\u2009years, a difference of 36\u00b0 (95% CI\u00a0=\u00a029\u00b0 to 43\u00b0) remained.\n <\/jats:p>\n <\/jats:sec>\n \n Interpretation<\/jats:title>\n Passive external rotation is not the explanatory limiting factor in the restoration of active external rotation after nerve surgery in children with upper\u2010trunk BPBI.<\/jats:p>\n <\/jats:sec>","DOI":"10.1111\/dmcn.70248","type":"journal-article","created":{"date-parts":[[2026,3,18]],"date-time":"2026-03-18T03:50:32Z","timestamp":1773805832000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Passive shoulder mobility and active shoulder external rotation recovery in upper\u2010trunk brachial plexus birth injuries after nerve repair"],"prefix":"10.1111","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7297-964X","authenticated-orcid":false,"given":"Eva T. E.","family":"Ulmann","sequence":"first","affiliation":[{"name":"Department of Neurosurgery Leiden University Medical Centre Leiden Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jochem","family":"Nagels","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery Leiden University Medical Centre Leiden Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6684-1302","authenticated-orcid":false,"given":"Willem","family":"Pondaag","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery Leiden University Medical Centre Leiden Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Martijn J. A.","family":"Malessy","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery Leiden University Medical Centre Leiden Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2026,3,17]]},"reference":[{"key":"e_1_2_8_2_1","doi-asserted-by":"crossref","first-page":"529","DOI":"10.1111\/j.1469-8749.2009.03479.x","article-title":"Obstetric brachial plexus palsy: a prospective, population\u2010based study of incidence, recovery, and residual impairment at 18\u2009months of age","volume":"52","author":"Lagerkvist AL","year":"2010","journal-title":"Dev Med Child Neurol"},{"key":"e_1_2_8_3_1","doi-asserted-by":"crossref","first-page":"673","DOI":"10.1111\/dmcn.14381","article-title":"Risk factors for neonatal brachial plexus palsy: a systematic review and meta\u2010analysis","volume":"62","author":"Van der Looven R","year":"2020","journal-title":"Dev Med Child Neurol"},{"key":"e_1_2_8_4_1","doi-asserted-by":"crossref","first-page":"138","DOI":"10.1111\/j.1469-8749.2004.tb00463.x","article-title":"Natural history of obstetric brachial plexus palsy: a systematic review","volume":"46","author":"Pondaag W","year":"2004","journal-title":"Dev Med Child Neurol"},{"key":"e_1_2_8_5_1","doi-asserted-by":"crossref","first-page":"668","DOI":"10.2106\/00004623-199805000-00007","article-title":"Glenohumeral deformity secondary to brachial plexus birth palsy","volume":"80","author":"Waters PM","year":"1998","journal-title":"J Bone Joint Surg Am"},{"key":"e_1_2_8_6_1","doi-asserted-by":"crossref","first-page":"935","DOI":"10.2106\/JBJS.I.00193","article-title":"Structural changes in muscle and glenohumeral joint deformity in neonatal brachial plexus palsy","volume":"92","author":"Hogendoorn S","year":"2010","journal-title":"J Bone Joint Surg Am"},{"key":"e_1_2_8_7_1","doi-asserted-by":"crossref","first-page":"173","DOI":"10.3171\/2008.12.PEDS0885","article-title":"Navigating the gray zone: a guideline for surgical decision making in obstetrical brachial plexus injuries","volume":"3","author":"Bain JR","year":"2009","journal-title":"J Neurosurg Pediatr"},{"key":"e_1_2_8_8_1","doi-asserted-by":"crossref","first-page":"87","DOI":"10.1016\/j.ejpn.2018.06.006","article-title":"Obstetric brachial plexus palsy \u2010 A prospective, population\u2010based study of incidence, recovery and long\u2010term residual impairment at 10 to 12\u2009years of age","volume":"23","author":"Annika J","year":"2019","journal-title":"Eur J Paediatr Neurol"},{"key":"e_1_2_8_9_1","doi-asserted-by":"crossref","first-page":"3147","DOI":"10.1080\/09638288.2017.1380717","article-title":"Participation restrictions among adolescents and adults with neonatal brachial plexus palsy: the patient perspective","volume":"40","author":"Holst M","year":"2018","journal-title":"Disabil Rehabil"},{"key":"e_1_2_8_10_1","doi-asserted-by":"crossref","first-page":"2163","DOI":"10.2106\/00004623-200410000-00006","article-title":"Neonatal brachial plexus palsy. Outcome of absent biceps function at three months of age","volume":"86","author":"Smith NC","year":"2004","journal-title":"J Bone Joint Surg Am"},{"key":"e_1_2_8_11_1","doi-asserted-by":"crossref","first-page":"706","DOI":"10.1177\/1753193417712924","article-title":"The natural history of recovery of elbow flexion after obstetric brachial plexus injury managed without nerve repair","volume":"42","author":"Hems TEJ","year":"2017","journal-title":"J Hand Surg Eur"},{"key":"e_1_2_8_12_1","doi-asserted-by":"crossref","first-page":"530","DOI":"10.1227\/01.NEU.0000170557.13788.D2","article-title":"External rotation as a result of suprascapular nerve neurotization in obstetric brachial plexus lesions","volume":"57","author":"Pondaag W","year":"2005","journal-title":"Neurosurgery"},{"key":"e_1_2_8_13_1","doi-asserted-by":"crossref","first-page":"1003","DOI":"10.1016\/j.jse.2013.09.031","article-title":"The role of muscle imbalance in the pathogenesis of shoulder contracture after neonatal brachial plexus palsy: a study in a rat model","volume":"23","author":"Soldado F","year":"2014","journal-title":"J Shoulder Elbow Surg"},{"key":"e_1_2_8_14_1","doi-asserted-by":"crossref","first-page":"461","DOI":"10.2106\/JBJS.J.00943","article-title":"Impaired growth of denervated muscle contributes to contracture formation following neonatal brachial plexus injury","volume":"93","author":"Nikolaou S","year":"2011","journal-title":"J Bone Joint Surg Am"},{"key":"e_1_2_8_15_1","doi-asserted-by":"crossref","first-page":"114","DOI":"10.1097\/CORR.0000000000000996","article-title":"What Range of Motion is Achieved 5\u2009Years After External Rotationplasty of the Shoulder in Infants with an Obstetric Brachial Plexus Injury?","volume":"478","author":"Sarac C","year":"2020","journal-title":"Clin Orthop Relat Res"},{"key":"e_1_2_8_16_1","doi-asserted-by":"crossref","first-page":"2533","DOI":"10.1002\/jor.23901","article-title":"Outcome assessment for Brachial Plexus birth injury. Results from the iPluto world\u2010wide consensus survey","volume":"36","author":"Pondaag W","year":"2018","journal-title":"J Orthop Res"},{"key":"e_1_2_8_17_1","first-page":"8","article-title":"Measurement of external rotation of the shoulder in patients with obstetric brachial plexus palsy","volume":"7","author":"Blaauw G","year":"2012","journal-title":"J Brachial Plex Peripher Nerve Inj"},{"key":"e_1_2_8_18_1","doi-asserted-by":"crossref","first-page":"1124.e1","DOI":"10.1016\/j.jhsa.2024.06.001","article-title":"Changes in Shoulder Rotation Based on Elevation in Children With Brachial Plexus Birth Injury","volume":"50","author":"Russo SA","year":"2025","journal-title":"J Hand Surg Am"},{"key":"e_1_2_8_19_1","doi-asserted-by":"crossref","first-page":"2008","DOI":"10.2106\/JBJS.22.00373","article-title":"Shoulder Internal Rotation Contracture Formation in Surgically Managed C5, C6 Brachial Plexus Birth Injuries: Neurotmetic Lesions Fare Worse Than Avulsions","volume":"104","author":"Ulmann ETE","year":"2022","journal-title":"J Bone Joint Surg Am"},{"key":"e_1_2_8_20_1","doi-asserted-by":"crossref","first-page":"257","DOI":"10.1097\/01.SAP.0000063750.16982.E4","article-title":"Obstetric brachial plexus palsy associated with breech delivery","volume":"51","author":"Al\u2010Qattan MM","year":"2003","journal-title":"Ann Plast Surg"},{"key":"e_1_2_8_21_1","doi-asserted-by":"crossref","first-page":"1268","DOI":"10.2106\/JBJS.20.01379","article-title":"Surgical Reconstruction of Isolated Upper Trunk Brachial Plexus Birth Injuries in the Presence of an Avulsed C5 or C6 Nerve Root","volume":"103","author":"Davidge KM","year":"2021","journal-title":"J Bone Joint Surg Am"},{"key":"e_1_2_8_22_1","doi-asserted-by":"crossref","first-page":"461","DOI":"10.2106\/JBJS.J.00943","article-title":"Impaired growth of denervated muscle contributes to contracture formation following neonatal brachial plexus injury","volume":"93","author":"Nikolaou S","year":"2011","journal-title":"J Bone Joint Surg Am"},{"key":"e_1_2_8_23_1","doi-asserted-by":"crossref","first-page":"2367","DOI":"10.2106\/JBJS.H.00417","article-title":"Correlation of radiographic muscle cross\u2010sectional area with glenohumeral deformity in children with brachial plexus birth palsy","volume":"91","author":"Waters P","year":"2009","journal-title":"J Bone Joint Surg Am"},{"key":"e_1_2_8_24_1","first-page":"15","article-title":"Clinical and neuropathological study about the neurotization of the suprascapular nerve in obstetric brachial plexus lesions","volume":"4","author":"Schaakxs D","year":"2009","journal-title":"J Brachial Plex Peripher Nerve Inj"},{"key":"e_1_2_8_25_1","doi-asserted-by":"crossref","DOI":"10.1097\/GOX.0000000000002605","article-title":"Mid\u2010Term Outcome after Selective Neurotization of the Infraspinatus Muscle in Patients with Brachial Plexus Birth Injury","volume":"8","author":"Grahn PM","year":"2020","journal-title":"Plast Reconstr Surg Glob Open"},{"key":"e_1_2_8_26_1","doi-asserted-by":"crossref","first-page":"117","DOI":"10.1111\/dmcn.15658","article-title":"Early referral to multidisciplinary specialty centers to optimize outcomes in children with neonatal brachial plexus palsy","volume":"66","author":"Muhlestein WE","year":"2024","journal-title":"Dev Med Child Neurol"},{"key":"e_1_2_8_27_1","doi-asserted-by":"crossref","first-page":"298","DOI":"10.2106\/JBJS.19.00627","article-title":"Reconstruction of the Suprascapular Nerve in Brachial Plexus Birth Injury: A Comparison of Nerve Grafting and Nerve Transfers","volume":"102","author":"Manske MC","year":"2020","journal-title":"J Bone Joint Surg Am"},{"key":"e_1_2_8_28_1","doi-asserted-by":"crossref","first-page":"1451","DOI":"10.1002\/mus.1168","article-title":"Obstetric lesions of the brachial plexus","volume":"24","author":"Gert van Dijk J","year":"2001","journal-title":"Muscle and Nerve"},{"key":"e_1_2_8_29_1","doi-asserted-by":"crossref","first-page":"19","DOI":"10.1016\/j.neures.2017.05.001","article-title":"Increased brain activation during motor imagery suggests central abnormality in neonatal brachial plexus palsy","volume":"123","author":"Anguelova GV","year":"2017","journal-title":"Neuroscience Research"},{"key":"e_1_2_8_30_1","doi-asserted-by":"crossref","first-page":"863","DOI":"10.1007\/s00264-010-0965-0","article-title":"Secondary gleno\u2010humeral joint dysplasia in children with persistent obstetric brachial plexus palsy","volume":"34","author":"Sibinski M","year":"2010","journal-title":"Int Orthop"},{"key":"e_1_2_8_31_1","doi-asserted-by":"crossref","DOI":"10.1155\/2014\/698256","article-title":"Peripheral nerve reconstruction after injury: a review of clinical and experimental therapies","volume":"2014","author":"Grinsell D","year":"2014","journal-title":"Biomed Res Int"}],"container-title":["Developmental Medicine & Child 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History"}},{"value":"2026-02-04","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-03-17","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"dmcn.70248"}}