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Outcomes of a Shoulder Treatment Flowchart in Patients With Axillary Burns

Webb, Darren C. MBBS*; Byrne, Martin BPO; Kolmus, Alison BPhysio*; Law, Henrietta Y. BPhysio*; Holland, Anne E. PhD*‡; Cleland, Heather MBBS, FRACS§∥

doi: 10.1097/BCR.0b013e31820aaeda
Original Articles

The purpose of this study was to evaluate the effects of a structured shoulder treatment flowchart on range of motion (ROM) and function of the upper limb in patients at high and low risk of contracture after an axillary burn injury. Consecutive patients with axillary burns were managed according to a structured pathway based on risk of contracture. Those patients with deep partial- or full-thickness burns to more than one area of the axilla or requiring more than one split skin graft were classified as high risk; these patients underwent a more aggressive approach to splinting and exercise. Measurements of shoulder ROM and functional ability (upper extremity functional index) were made at admission, hospital discharge, and at 12 weeks postdischarge. Twenty patients (19 men) with an average age of 39 years and a median TBSA of 20% were recruited. Median length of stay was 18 days. Ten patients were classified as high risk. Both low-risk and high-risk patients showed good range of movement outcomes at discharge and 12 weeks, with no significant differences between risk groups (abduction at 12 weeks, mean [SD]: 168° [22°] vs 166° [28°], P = .60; flexion at 12 weeks, mean [SD]: 172° [20°] vs 167° [31°], P = .60, respectively). There were no differences in functional outcomes at 12 weeks postdischarge. Use of a shoulder treatment pathway was associated with good shoulder ROM and functional capacity in patients at high and low risk of axillary contracture.

From the Departments of *Physiotherapy, †Orthotics and Prosthetics, and §Burns, The Alfred Hospital; ‡La Trobe University; and ∥the Plastic Surgery Unit, The Royal Children's Hospital, Melbourne, Victoria, Australia.

Supported by the Alfred Research Trust.

Address correspondence to Darren C. Webb, MBBS, Physiotherapy Department, Alfred Hospital, Commercial Road, Melbourne, Victoria 3004, Australia.

© 2011 The American Burn Association