Is the Toronto scoring system useful for monitoring the progress of radial nerve palsy in newborn babies

Introduction: The Toronto scoring system is used commonly for brachial plexus injuries by physiotherapists and its role in radial nerve palsy is indeterminate. Aim: To determine if the Toronto scoring system is useful for monitoring the progress and predicting the prognosis of radial nerve palsy. Methods: The Toronto score assessment for radial nerve palsy was based on the range of motion achieved at the elbow, wrist and finger joints with and without gravity eliminated. Flexion and extension was assessed at each joint and scored from zero (no contraction) to two (full motion). Four term babies born at St. Mary’s Hospital, Manchester with isolated radial nerve palsy were reviewed at birth by paediatric physiotherapists. They were given a Toronto score at initial assessment. Subsequently they were reviewed 1-2 weekly and evaluated using the Toronto scoring system. A final evaluation was done prior to discharge. Results: The Toronto score pre-treatment ranged from 2.3 to 4.9. All four babies received physiotherapy. Physiotherapy was provided with thermoplastic splints for 2 babies and no splints for the remaining two. The Toronto score at the end of 5 weeks of treatment was 10 in three babies. One baby had a Toronto score of 9.3 at 4 weeks of age, when the baby was lost to follow-up. Conclusion: Toronto score is a useful for monitoring the progress of radial nerve palsy. But in our small series of four patients a low Toronto score at initial assessment did not predict time to recovery.