Criteria
Narakas classification[13][14]
Defines the injured nerves and directs attention to potential areas of concern during recovery.
Group 1: C5-C6 injury (upper Erb's palsy)
Paralysis of shoulder and biceps
Rate of spontaneous recovery >80%
Group 2: C5, C6, C7 injury (extended Erb's palsy)
Paralysis of shoulder, biceps, and wrist extensors
Rate of spontaneous recovery around 60%
Group 3: C5, C6, C7, C8, T1 injury (total palsy with no Horner's sign)
Paralysis of entire limb
Rate of spontaneous recovery <50%
Group 4: C5, C6, C7, C8, T1 injury (total palsy with Horner's sign)
Paralysis of entire limb with Horner's sign
Rate spontaneous recovery around 0%.
Modifications (including an extended Narakas classification with 5 groups) have been described but are rarely used.[12][14]
Seddon classification[85]
Severity of the nerve injury determines the potential for recovery. Complete rupture will require surgical repair, whereas stretch injury will often recover with time:
Neurapraxia: stretch injury of the nerve
Axonotmesis: rupture of the axon with intact nerve sheath
Neurotmesis: complete rupture of the nerve.
Toronto test score[53]
Defines the injured area in relation to 5 observed movements of the hand and elbow
Does not assess shoulder function
Graded on a scale of 0 (no motion) to 2 (normal full motion); can add up to a maximum of 10 points for the 5 movements assessed. Lower scores indicate patients who may benefit from nerve repair surgery.
Active movement scale[48][54]
Defines the injured nerves and can be used to monitor recovery from the initial injury and after surgical repair
Consists of observation of movements of multiple joints and muscle groups, including shoulder function
More global than the Toronto test score
Each 1 of 15 different active upper-extremity movements is tested without gravity and against gravity and is scored on a scale of 0 to 7.
Mallet scale[55]
Evaluates shoulder function in older patients who can cooperate with instructions
Can be used to follow function over time and to evaluate the outcomes of surgical interventions
Uses a grading scale of 1 (no movement) to 5 (normal motion; symmetric to the unaffected, contralateral side) for each of the 5 voluntary movements tested
A modified Mallet classification is most commonly used, for which categories 1 and 5, belonging to either totally paralysed or normal children, have been eliminated.
Medical Research Council motor scale[57]
Commonly used to evaluate muscle strength, but use in babies is controversial as they cannot follow instructions.
0: no movement
1: flicker of movement but no active movement
2: active movement with gravity eliminated
3: anti-gravity movement
4: movement against some resistance
5: normal power.
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