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Topic:

​

Issue:

Shoulder

Category:

Research

Title:

Shoulder Motion Overestimated by Mallet Scores

Author:

Lovette, Madison MS; Chafetz, Ross S. DPT, PhD; Russo, Stephanie A. MD, PhD; Kozin, Scott H. MD; Zlotolow, Dan A. MD

Journal:

Journal of Pediatric Orthopaedics

Date:

November/December 2024

Reference:

44(10): p e951-e956, DOI: 10.1097/BPO.0000000000002775

Level Of Evidence:

IV

# of Patients:

107

Study Type:

Retrospective study

Location:

Single institution (likely pediatric center)

Summary:

This study investigates the accuracy of the Mallet classification scores for shoulder motion in children with brachial plexus birth injury (BPBI). Motion capture was used to compare the actual shoulder motions to the Mallet scores, revealing discrepancies, particularly for external rotation and hand-to-mouth scores.

Methods:

Retrospective review of clinical data where 107 children with BPBI underwent both motion capture assessment and clinical Mallet score determination. The study assessed humerothoracic elevation and external rotation joint angles during abduction, external rotation, and hand-to-mouth movements, then compared the motion capture data to the clinician-determined Mallet scores.

Exclusions:

None specified

Results:

For abduction, 24.3% of Mallet scores were misclassified. Most misclassifications (22) were overestimated by 1 point, while 4 were underestimated by 1 point compared to motion capture data. For external rotation, 72.9% of Mallet scores were misclassified. Of the 5 patients with humerothoracic elevation less than 40 degrees, 4 (80%) had a Mallet hand-to-mouth score of 4. There were no significant differences in the proportion of patients with humerothoracic elevation less than 40 degrees and their Mallet score (4 or less).

Conclusions:

The study found better agreement between motion capture and Mallet scores for abduction, while external rotation and hand-to-mouth scores were more frequently misclassified. The misclassification suggests that the Mallet scores may not be fully accurate, particularly for assessing external rotation and hand-to-mouth movements. This inaccuracy is concerning, as these scores are used for surgical indications and outcome measures.

Relevance:

Limitations:

Perspective:

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