{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,22]],"date-time":"2026-09-22T10:39:34Z","timestamp":1790073574976,"version":"4.0.1"},"reference-count":32,"publisher":"SAGE Publications","issue":"3","license":[{"start":{"date-parts":[[2021,11,11]],"date-time":"2021-11-11T00:00:00Z","timestamp":1636588800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["J Hand Surg Eur Vol"],"published-print":{"date-parts":[[2022,3]]},"abstract":"<jats:p>Children with permanent brachial plexus birth injury have a high risk of developing posterior shoulder subluxation. In 2010, we implemented a protocol to reduce the incidence of this deformity, including early passive exercises, ultrasound screening, botulinum toxin-A injections, shoulder splinting and targeted surgeries. Two-hundred and thirty-seven consecutive children treated at our institution, with a mean follow-up of 11 years (range 1 to 17) were compared in three groups: children born from 1995 to 1999 ( n\u2009=\u200953), 2000\u20132009 ( n\u2009=\u2009109) and 2010\u20132019 ( n\u2009=\u200975). Posterior shoulder subluxation developed in 48% of all patients but the mean age at detection of shoulder subluxation decreased from 5 years to 4.9\u00a0months. Need for shoulder relocation surgery also decreased from 28% to 7%. Mean active shoulder external rotation in adduction improved from 2\u00b0 to 46\u00b0. In conclusion, our established protocol has the potential to reduce the incidence of posterior shoulder subluxation in children with brachial plexus birth injury.<\/jats:p>\n                  <jats:p>Level of evidence: II<\/jats:p>","DOI":"10.1177\/17531934211056998","type":"journal-article","created":{"date-parts":[[2021,11,11]],"date-time":"2021-11-11T22:48:50Z","timestamp":1636670930000},"page":"248-256","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":16,"title":["A protocol-based treatment plan to improve shoulder function in children with brachial plexus birth injury: a comparative study"],"prefix":"10.1177","volume":"47","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3018-8270","authenticated-orcid":false,"given":"Petra","family":"Grahn","sequence":"first","affiliation":[{"name":"Department of Pediatric Orthopedics and Traumatology, HUS Helsinki University Hospital, Helsinki, Finland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Antti","family":"Sommarhem","sequence":"additional","affiliation":[{"name":"Department of Surgery, South Karelia Central Hospital, Lappeenranta, Finland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yrj\u00e4n\u00e4","family":"Nietosvaara","sequence":"additional","affiliation":[{"name":"Department of Pediatric Orthopedics and Traumatology, HUS Helsinki University Hospital, Helsinki, Finland"},{"name":"Department of Pediatric Surgery, Kuopio University Hospital, Kuopio, Finland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2021,11,11]]},"reference":[{"key":"bibr1-17531934211056998","doi-asserted-by":"publisher","DOI":"10.1097\/01.PRS.0000146871.94229.91"},{"key":"bibr2-17531934211056998","doi-asserted-by":"publisher","DOI":"10.2106\/JBJS.16.00806"},{"key":"bibr3-17531934211056998","doi-asserted-by":"publisher","DOI":"10.1097\/PRS.0b013e3181a80798"},{"key":"bibr4-17531934211056998","doi-asserted-by":"publisher","DOI":"10.1177\/1558944718760038"},{"key":"bibr5-17531934211056998","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhsa.2013.12.016"},{"key":"bibr6-17531934211056998","doi-asserted-by":"publisher","DOI":"10.2106\/JBJS.I.00499"},{"key":"bibr7-17531934211056998","doi-asserted-by":"publisher","DOI":"10.1097\/GOX.0000000000002605"},{"key":"bibr8-17531934211056998","doi-asserted-by":"publisher","DOI":"10.1097\/BPO.0000000000000735"},{"key":"bibr9-17531934211056998","doi-asserted-by":"publisher","DOI":"10.1055\/s-2004-837258"},{"key":"bibr10-17531934211056998","doi-asserted-by":"publisher","DOI":"10.2106\/00004623-200302000-00020"},{"key":"bibr11-17531934211056998","doi-asserted-by":"publisher","DOI":"10.1111\/j.1469-8749.2004.tb00455.x"},{"key":"bibr12-17531934211056998","doi-asserted-by":"publisher","DOI":"10.1191\/0269215500cr341oa"},{"key":"bibr13-17531934211056998","doi-asserted-by":"publisher","DOI":"10.1097\/01241398-200301000-00022"},{"key":"bibr14-17531934211056998","doi-asserted-by":"publisher","DOI":"10.2106\/00004623-200701000-00003"},{"key":"bibr15-17531934211056998","first-page":"166","volume":"58","author":"Mallet J","year":"1972","journal-title":"Rev Chir Orthop Reparatrice Appar Mot"},{"key":"bibr16-17531934211056998","doi-asserted-by":"publisher","DOI":"10.1016\/j.pmrj.2014.05.002"},{"key":"bibr17-17531934211056998","doi-asserted-by":"publisher","DOI":"10.1097\/00006534-199404000-00001"},{"key":"bibr18-17531934211056998","doi-asserted-by":"publisher","DOI":"10.2106\/00004623-200404000-00018"},{"key":"bibr19-17531934211056998","unstructured":"Narakas AO. 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