Mallet classification

Recovery after brachial plexus injury

Abduction

  • Grade I: No active motion
  • Grade II: <30°
  • Grade III: 30° - 90°
  • Grade IV: >°
  • 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).

Reference

Brachial PlexusPalsies in Infants and Children.North Pacific Pediatric Society March 11, 2011. Raymond Tse, MD Brachial Plexus Program Seattle Children’s Hospital.

Neurological recovery in obstetric brachial plexus injuries: an historical cohort study. Agnes F Hoeksma* Developmental Medicine & Child Neurology 2004, 46: 76–83

Function of the upper limb after surgery for obstetric brachial plexus palsy. C. E. Dumont, V. Forin, H. Asfazadourian, C. Romana From Hôpital d’Enfants Armand Trousseau, Paris, France. J Bone Joint Surg [Br] 2001;83-B:894-900.