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Special Test

Towel Test

Towel test is used to evaluate the children with brachial plexus palsy. It was described by Bertelli and Ghizoni.

How do you perform the Towel Test?

The child’s face is covered with a towel in a supine position and the unaffected arm is obstructed. The child will attempt to remove the towel using the unobstructed affected arm.

See Also:

Towel Test brachial plexus palsy
Towel Test brachial plexus palsy

What does a positive Towel Test mean?

To remove the towel, shoulder flexion, elbow flexion and extension, and finger flexion and extension are needed, and hence these movements can be assessed.
If the child is able to remove the towel, it is considered a pass, suggestive of recovery of involved muscles, particularly elbow flexion.

Releability

 The towel test is a reliable technique for evaluating children with obstetric brachial plexus injuries.

Modified Towel Test

Eye obstruction test is a modification of Towel test, where the eyes are covered using the examiner’s hand instead of a towel. The child would immediately try to remove the hands with the action of the biceps and elbow flexion.

Modified Towel Test
Modified towel test/eye obstruction test. The eyes are obstructed, and the unaffected limb is restrained to assess the elbow flexion of the affected limb.

Brachial Plexus Palsy

Flaccid paralysis of the upper extremity due to stretching of the brachial plexus that occurs at the time of birth is defined as birth brachial plexus palsy (BBPP). This condition was earlier known as “obstetric brachial plexus injury.”

However, the term is not used anymore to avoid direct reference to obstetricians as the causative factor. Broadly, BBPP is classified into two:

  • Early or infantile seen in less than 1 year of life.
  • Late presentation is seen in children more than 1-year-old with sequelae such as secondary contractures or deformities.

Before proceeding to examine a child with BBPP, one should be familiar with the common clinical presentations to rapidly and accurately identify the involved roots.

Narakas has classified these common clinical presentations based on the roots involved, and this is the most commonly used classifcation.

  • Upper Erb’s palsy, C5, C6.
  • Extended Erb’s palsy, C5, C6, C7.
  • Total palsy without Horner syndrome, C5–T1.
  • Total palsy with Horner syndrome, C5–T1.
Roots InvolvedClassic Clinical Presentations
Classic Duchenne C5, C6Shoulder internally rotated, adducted; elbow extended; Erb’s palsy forearm pronated; hand and finger preserved
Upper middleC5, C6, C7Same as above; forearm pronated with palm facing backward. trunk BBPP Classic waiter’s tip deformity.
Klumpke’s palsy C8, T1Loss of function of small muscles of hand, sensory loss over medial arm and forearm.
Pan plexus injury C5–T1• Pre-ganglionic: Flail limb, Horner syndrome+
• Post-ganglionic: Flail limb, Horner syndrome-, serratus anterior and rhomboids function is preserved.

Question & Answer

What is Towel Test used for?

Towel Test is used for brachial plexus palsy in children. It’s also used to evaluate the recovery of the disease.

Is Towel Test releable?

The towel test is considered a reliable test to detect the child with obstetric brachial plexus injury.

References

  1. Bertelli JA, Ghizoni MF. The towel test: a useful technique for the clinical and electromyographic evaluation of obstetric brachial plexus palsy. J Hand Surg Br. 2004 Apr;29(2):155-8. doi: 10.1016/j.jhsb.2003.10.018. PMID: Pubmed.
  2. Bertelli JA, Ghizoni MF. The towel test: A useful technique for the clinical and electromyographic evaluation of obstetric brachial plexus palsy’, J Hand Surg Br. 2004;29(2):155–158. Pubmed
  3. Chuang DC, Mardini S, Ma HS. Surgical strategy for infant obstetrical brachial plexus palsy: Experiences at Chang Gung Memorial Hospital. Plast Reconstr Surg. 2005;116:132–142.
  4. Al-Qattan MM, El-Sayed AA, Al-Zahrani AY, et al. Narakas classifcation of obstetric brachial plexus palsy revisited. J Hand Surg Eur. 2009;34(6):788–791.
  5. Erb W. Uber eine eigentumliche Lokalisation von Lahmugenim Plexus brachialis, Verhandl Naturhist Med Vereins. Heidelberg ‘Carl Winters’. Universitatas Buchhandlung 1874;2:130–136.
  6. Klumpke A. Contribution a letude des paralysies radiculaires du plexus brachial. Paralysies radiculaires totals. De la participation des flets sympathiques oculo-pupillaires dans ces paralysies. Rev Med. 1885;5:591–616.
  7. Bhardwaj P, Venkatramani H, Sbapathy SR. A modifed towel test for assessment of elbow fexion in children less than 9 months old with brachial plexus birth palsy. J Hand Surg Eur..2011;36:707–708.
Last Reviewed
December 24, 2023
Contributed by
OrthoFixar

Orthofixar does not endorse any treatments, procedures, products, or physicians referenced herein. This information is provided as an educational service and is not intended to serve as medical advice.

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