Alterations in Functional Movement After Axillary Burn Scar Contracture: A Motion Analysis Study

Abstract

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

Upper extremity kinematics during functional activities: Three-dimensional studies in a normal pediatric population

“…Prospective studies with pathologic populations might use this standardized protocol to compare and evaluate kinematic data relative to this established pediatric database. This UE motion analysis protocol is currently being used to study the effects of shoulder external rotation tendon transfers and humeral osteotomies in children with brachial plexus birth palsy [16] and the results of axillary contracture releases in burned children [17]. UE pathologic data can be superimposed over age matched normative curves in the same manner as pathologic gait data is superimposed over normative gait curves.…”

“…Trunk flexion (9-12) vs. (13)(14)(15)(16)(17)(18) .007 Wrist radial (9)(10)(11)(12) vs. (13)(14)(15)(16)(17)(18) .002 a Joint angle difference between age groups >108 Wrist extension À17(9) À27 (12) .002…”

“…Arm pronation (5-8) vs. (9)(10)(11)(12) .001 a Wrist radial (5)(6)(7)(8) vs. (13)(14)(15)(16)(17)(18) .004…”

Reliability of upper and lower limb three-dimensional kinematics in children with hemiplegia

“…However, several 3D upper limb kinematic models have recently been described in the literature [17,18]. Preliminary assessments of 3D upper limb kinematic function have been made with two clinical populations, including the assessment of movement limitations following burn scar contracture [19] and the assessment of a child with brachial plexus palsy [15].…”

Repeatability of upper limb kinematics for children with and without cerebral palsy

“…However, in those studies that have attempted to categorise upper limb kinematics using 3D motion analysis in clinical populations [6,8,[16][17][18][19], the methodology, biomechanical models, marker positions, movement tasks, axial definitions and orders of rotations all vary quite dramatically. Recommendations for the standardisation of axial definition for the hand, wrist, elbow and shoulder exist within the framework of the International Society of Biomechanics (ISB) [20].…”