{"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":1790073574344,"version":"4.0.1"},"reference-count":15,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"9","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["The Journal of Bone and Joint Surgery"],"published-print":{"date-parts":[[2017,5,3]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>Early detection of posterior shoulder dislocation in infants with brachial plexus birth palsy (BPBP) is essential, but it may be difficult to accomplish with physical examination alone. The aim of this study was to determine the prevalence of shoulder dislocation in patients with BPBP using ultrasound and to identify which physical examination measurements correlated most with dislocation in these patients.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>This study was a retrospective review of data obtained in an ultrasound screening program of infants with BPBP born from January 2011 to April 2014. Physical examination included the use of the Active Movement Scale (AMS) and measurement of passive external rotation of the shoulder. Ultrasound measurements included PHHD (percentage of the humeral head displaced posterior to the axis of the scapula) and the alpha angle (intersection of the posterior scapular margin with a line tangential to the humeral head through the glenoid). Shoulder dislocation was defined as both a PHHD of &gt;0.5 and an alpha angle of &gt;30\u00b0.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>Of sixty-six infants who had undergone a total of 118 ultrasound examinations (mean, 1.8; range, 1 to 5), 19 (29%) demonstrated shoulder dislocation with the shoulder positioned in internal rotation; the dislocation was first detected between 2.1 and 10.5 months of age. Infants with a dislocated shoulder demonstrated significantly less mean passive external rotation in adduction (mean, 45.8\u00b0 versus 71.4\u00b0, p &lt; 0.001) and a greater difference between internal rotation and external rotation AMS scores (mean, 5.5-point versus 3.3-point difference, p &lt; 0.001) than those without shoulder dislocation. Passive external rotation in adduction was a better measure for discriminating between dislocation and no dislocation (area under receiver operating characteristic curve [AUC] = 0.89) than was the difference between internal and external rotation AMS scores (AUC = 0.73). A cutoff of 60\u00b0 of passive external rotation in adduction (\u226460\u00b0 versus\u00b0 &gt;60) yielded a sensitivity of 94% and a specificity of 69%.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>Shoulder dislocation is common in infants with BPBP; 29% of the infants presenting to our tertiary care center had a dislocation during their first year of life. Ultrasound shoulder screening is appropriate for infants with BPBP. If passive external rotation in adduction is used to determine which infants should undergo ultrasound, \u226460\u00b0 should be utilized as the criterion to achieve appropriate sensitivity.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Level of Evidence:<\/jats:title>\n                    <jats:p>\n                      Therapeutic\n                      <jats:underline>Level IV<\/jats:underline>\n                      . See Instructions for Authors for a complete description of levels of evidence.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.2106\/jbjs.16.00806","type":"journal-article","created":{"date-parts":[[2017,5,3]],"date-time":"2017-05-03T13:40:04Z","timestamp":1493818804000},"page":"778-783","source":"Crossref","is-referenced-by-count":41,"title":["Ultrasound Screening for Posterior Shoulder Dislocation in Infants with Persistent Brachial Plexus Birth Palsy"],"prefix":"10.2106","volume":"99","author":[{"given":"Andrea S.","family":"Bauer","sequence":"first","affiliation":[{"name":"Department of Orthopaedic Surgery (A.S.B.) and Clinical Research Center (L.A.K.), Boston Children\u2019s Hospital, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Justin F.","family":"Lucas","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, University of California Davis Medical Center, Sacramento, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nasser","family":"Heyrani","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, University of California Davis Medical Center, Sacramento, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ryan L.","family":"Anderson","sequence":"additional","affiliation":[{"name":"University of California Davis School of Medicine, Sacramento, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Leslie A.","family":"Kalish","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery (A.S.B.) and Clinical Research Center (L.A.K.), Boston Children\u2019s Hospital, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michelle A.","family":"James","sequence":"additional","affiliation":[{"name":"Shriners Hospitals for Children\u2014Northern California, Sacramento, California"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"issue":"5","key":"bib1-20230810","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","year":"2011","journal-title":"J Bone Joint Surg Am."},{"issue":"4679","key":"bib2-20230810","doi-asserted-by":"crossref","first-page":"1217","DOI":"10.1016\/S0140-6736(00)52017-0","article-title":"Birth palsy: subluxation of the shoulder-joint in infants and young children","volume":"181","author":"Fairbank","year":"1913","journal-title":"Lancet."},{"issue":"5","key":"bib3-20230810","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","year":"1998","journal-title":"J 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palsy","volume":"27","author":"Curtis","year":"2002","journal-title":"J Hand Surg Am."},{"issue":"9","key":"bib10-20230810","doi-asserted-by":"crossref","first-page":"1531","DOI":"10.7863\/ultra.32.9.1531","article-title":"Dynamic sonographic evaluation of posterior shoulder dislocation secondary to brachial plexus birth palsy injury","volume":"32","author":"Sanchez","year":"2013","journal-title":"J Ultrasound Med."},{"issue":"2","key":"bib11-20230810","doi-asserted-by":"crossref","first-page":"320","DOI":"10.2106\/00004623-200502000-00013","article-title":"Effect of tendon transfers and extra-articular soft-tissue balancing on glenohumeral development in brachial plexus birth palsy","volume":"87","author":"Waters","year":"2005","journal-title":"J Bone Joint Surg Am."},{"issue":"12","key":"bib12-20230810","doi-asserted-by":"crossref","first-page":"2171","DOI":"10.2106\/JBJS.I.00499","article-title":"Onabotulinum toxinA injection as an adjunct in the treatment of posterior shoulder subluxation in neonatal brachial plexus palsy","volume":"92","author":"Ezaki","year":"2010","journal-title":"J Bone Joint Surg Am."},{"issue":"4","key":"bib13-20230810","doi-asserted-by":"crossref","first-page":"371","DOI":"10.1097\/BPO.0b013e3181d8d34d","article-title":"Glenohumeral dysplasia changes after tendon transfer surgery in children with birth brachial plexus injuries","volume":"30","author":"Van Heest","year":"2010","journal-title":"J Pediatr Orthop."},{"issue":"3","key":"bib14-20230810","first-page":"564","article-title":"Arthroscopic release and latissimus dorsi transfer for shoulder internal rotation contractures and glenohumeral deformity secondary to brachial plexus birth palsy","volume":"88","author":"Pearl","year":"2006","journal-title":"J Bone Joint Surg Am."},{"issue":"1","key":"bib15-20230810","doi-asserted-by":"crossref","first-page":"253","DOI":"10.1148\/radiol.09090570","article-title":"Brachial plexus birth injury: US screening for glenohumeral joint instability","volume":"254","author":"P\u00f6yhi\u00e4","year":"2010","journal-title":"Radiology."}],"container-title":["Journal of Bone and Joint Surgery"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ovid.com\/00004623-201705030-00009","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T13:35:26Z","timestamp":1787751326000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ovid.com\/00004623-201705030-00009"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2017,5,3]]},"references-count":15,"journal-issue":{"issue":"9","published-print":{"date-parts":[[2017]]}},"URL":"https:\/\/doi.org\/10.2106\/jbjs.16.00806","relation":{},"ISSN":["0021-9355","1535-1386"],"issn-type":[{"value":"0021-9355","type":"print"},{"value":"1535-1386","type":"electronic"}],"subject":[],"published":{"date-parts":[[2017,5,3]]}}}