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Children with axillary burns often develop scar contractures that restrict shoulder movement. Objective data on functional movement patterns after contracture formation is sparse. The purpose of this study was to determine how axillary contractures affect shoulder movement during activities of daily living (ADLs). This was a prospective study of children with axillary contractures scheduled for surgical release. Three-dimensional upper extremity kinematic analysis was used to assess shoulder, elbow, and trunk motion during two ADLs: high reach and hand to back pocket. Results were compared with a pool of 49 normal agematched controls. Eleven children with axillary contractures were compared with controls. Each year, over 2.5 million people seek medical assistance for acute burn injuries, and approximately 100,000 are hospitalized, including a large number of children.1 The yearly direct and indirect costs of burn injury are enormous. The average cost of hospital care for a patient with burns ranges from $29,560 to $117,506; this figure rises significantly for patients with extensive burns.2 A large proportion of these costs can be directly attributed to the management of burn scars.Children in particular are subject to the development of severe burn scar contractures. Normal growth, graft loss or shrinkage, and inadequate therapy can combine to result in the development of significant burn scar contractures. These contractures can lead to restriction of extremity movement, particularly over major joints, such as the axilla and knee. Contracture release is performed to restore "normal" range of motion in burned extremities. A review of more than 3000 survivors of burn injury revealed that approximately 20% of patients require some type of reconstructive procedure.3 Although numerous studies assess the appearance of postburn scar contracture release, the immediate and long-term effects of contracture release on extremity function have received little attention. -9The current standard for assessing the severity of burn scar contractures involves measuring the passive and active range of motion of an extremity in a single plane. Although this provides clinicians with valuable data, these measurements do not give information on functional motion or how the extremity moves during activities of daily living (ADLs), such as bathing, dressing, or toileting. A patient with a significant axillary contracture may not be able to raise an arm above his or her head but may still able to comb his or her hair by using different maneuvers. Objective characterization of changes in extremity kinematics, or how an extremity compensates to perform functional tasks, is needed to define the goals of reconstructive surgery.Three-dimensional motion analysis, which involves the calculation of extremity motion relative to anatomic

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Children with brachial plexus birth palsy (BPBP) may have shoulder external rotation and abduction weakness that can restrict activities of daily living (ADLs). Static range of motion measurements may not measure ADL restrictions. Motion analysis has been used to quantify gait limitations and measure changes associated with treatment. The purpose of this study was to determine whether upper extremity motion analysis (UEMA) can measure the differences in shoulder motion during ADLs between children with BPBP and normal children. Following a previously described UEMA protocol, 55 children with BPBP and 51 normal children (control group) were studied. Kinematic data of selected ADLs were collected before surgery. UEMA was used to measure statistically significant differences between children with BPBP and control subjects for all planes of shoulder motion in all activities tested. The authors conclude that UEMA can discriminate between children with BPBP and control subjects during selected ADLs, and suggest that UEMA can also be used to measure the effects of surgical interventions in children with BPBP.