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3D Motion Analysis of Shoulder Function Correlates with Patient-Reported Outcome Measures after Surgery for Traumatic Brachial Plexus Injury
Christopher J Dy, MD1; Rannon Huo, HSD1; Yosita P Beamer, MBS1; David M Brogan, MD, MSc2; Michael Harris, PhD1
1Washington University in St. Louis, St. Louis, MO; 2Washington University School of Medicine, St. Louis, MO

INTRODUCTION: There is enthusiasm to improving outcome assessment after brachial plexus injury (BPI), with an emphasis on measuring how much patients use their reconstructed upper extremity. To supplement surgeon-graded muscle strength and patient-reported outcome measures, we have incorporated 3D motion capture into our outcome measures to evaluate “real world” use.
MATERIALS & METHODS: For 5 patients after BPI reconstruction, we placed retroreflective markers at anatomical landmarks on the upper limbs and torso per the standardized Vicon Upper Limb Model (FIGURE). We captured motions with near-infrared motion capture cameras at 100 Hz. We recorded marker trajectories as the patient brought their (1) hand to mouth and (2) hand to occiput. From the marker trajectories, we created a 3D virtual model of the patient and calculated joint angles of the elbow and shoulder. We normalized and averaged joint angles and accelerations across repetitions trials per task. All patients also completed DASH, Impact of BPI (a validated BPI-specific patient reported outcome measure), and PROMIS Pain Interference assessments.
RESULTS: Patient-specific details regarding manual muscle testing, patient-reported outcomes, and 3D-measured ROM are included in the Table. The average time from surgery to data collection was 25 months (range 15-40mo). For the action of hand-to-mouth, there were strong correlations between patient-reported disability and 3D-measured shoulder abduction (Abd) (r=-0.65), shoulder forward flexion (FF) (r=-0.73). For the action of hand-to-occiput, there were very strong correlations between disability and Abd (r=-0.89) and SFF (r=-0.85). For both actions, there was no correlation between disability and elbow flexion (EF) (hand-to-mouth r=-0.05; hand-to-occiput r=0.001). There were strong correlations between SFF and pain interference (hand-to-mouth r=--0.76; hand-to-occiput r=-0.96), but mild correlations for EF (hand-to-mouth r=-0.31; hand-to-occiput r=-0.36).
CONCLUSIONS: In this pilot study, we demonstrated the use of 3D motion analysis of shoulder and elbow function after BPI reconstruction. We noted that both patient-reported disability and pain interference correlate strongly with shoulder function, but not with elbow flexion. These findings emphasize the need to prioritize restoration of shoulder function for BPI patients. We are expanding the use of 3D motion in our practice to provide enhanced assessment of upper extremity use.


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