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Recovery after brachial plexus injury - Mallet classification

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Classification

Abduction

  • Grade I: No active motion
  • Grade II: <30°
  • Grade III: 30° - 90°
  • Grade IV: >90°
  • Grade V: Normal movement

External rotation

  • Grade I: No active motion
  • Grade II: 0°
  • Grade III: <20°
  • Grade IV: >20°
  • Grade V: Normal movement

Hand to head

  • Grade I: No active motion
  • Grade II: Impossible
  • Grade III: Difficult
  • Grade IV: Easy
  • Grade V: Normal movement

Hand to back

  • Grade I: No active motion
  • Grade II: Impossible
  • Grade III: To S1 level
  • Grade IV: To T12 level
  • Grade V: Normal movement

Hand to mouth

  • Grade I: No active motion
  • Grade II: Trumpet sign
  • Grade III: Partial trumpet sign
  • Grade IV: <40° abduction
  • Grade V: Normal movement

The "trumpet sign" is named after the way of holding the trumpet in a particular unit of the French army (almost 90° abduction of affected arm when bringing hand to the mouth).

Explanation

Provide an explanation for key principles and pertinent aspects of the classification

Figures


Image from Aydin A, Ozkan T, Onel D. Does preoperative abduction value affect functional outcome of combined muscle transfer and release procedures in obstetrical palsy patients with shoulder involvement? BMC Musculoskeletal Disorders 2004,5:25; http://www.biomedcentral.com/1471-2474/5/25; accessed May 22, 2012.

Reference(s)

Provide the citation for the landmark article and recent review articles describing the classification

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