Mallet Grading System for Shoulder Function in Obstetrical Brachial Plexus Palsy

Mallet reported a grading system for shoulder function in patients with obstetrical brachial plexus palsy.

Parameter:

(1) active abduction in degrees

(2) degrees of external rotation

(3) hand to back of neck

(4) hand to back

(5) hand to mouth

(6) flail shoulder

Parameter	Finding	Grade
active abduction	<= 30°	II
	30 to 90°	III
	> 90°	IV
degrees of external rotation	0°	II
	1 to 20°	III
	> 20°	IV
hand to back of neck	impossible	II
	with difficulty	III
	easy	IV
hand to back	impossible	II
	with difficulty	III
	easy	IV
hand to mouth	marked trumpet sign	II
	partial trumpet sign (> 40° of shoulder abduction)	III
	< 40° shoulder abduction	IV

where:

• Trumpet sign refers to shoulder abduction with elbow flexion.

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