CC BY-NC-ND 4.0 · Indian Journal of Neurotrauma 2022; 19(01): 029-033
DOI: 10.1055/s-0041-1732787
Original Article

Reliability of Towel Test for Elbow Flexion Assessment in Brachial Plexus Birth Palsy

J. Terrence Jose Jerome
1   Department of Orthopedics, Hand and Reconstructive Microsurgery, Olympia Hospital and Research Centre, Trichy, Tamil Nadu, India
S. Vanathi
2   Department of Microbiology, K.A.P. Viswanatham Government Medical College, Trichy, Tamil Nadu, India
G. Ramesh Prabu
3   Department of Orthopedics, KAPV Medical College Hospital, Trichy, Tamil Nadu, India
K. Thirumagal
4   Olympia Hospital and Research Centre, Trichy, Tamil Nadu, India
› Author Affiliations
Funding None.


Background and Objectives The towel test is a reliable and straightforward technique to find elbow flexion in brachial plexus birth palsy. This study evaluates the role and reliability of towel test in children at 6 and 9 months of age.

Materials and Methods We conducted the towel test in 30 consecutive children at 6 and 9 months of their ages between 2015 and 2020. We recorded the results along with the side involved in these children and the mother’s handedness. Based on the results of towel tests, we did a statistical correlation.

Results Sixteen of the 30 children were boys. Twelve of the 30 children had left-side involvement. Four mothers were left handed. Four (13%) infants (male = 3; female = 1) had false-negative towel test at 6 and 9 months. There is a significant correlation between the left-hand mother’s and infant who had false-negative towel test (p < 0.01)

Conclusion The towel test is reliable and straightforward to assess the elbow flexion at 6 and 9 months. It can be falsely negative in 13% of children because of handedness. Mother’s handedness is crucial and should be recorded during the children assessment. Alternate tests will further evaluate the elbow flexion in such false-negative towel-tested brachial plexus birth palsy children.

Publication History

Article published online:
24 August 2021

© 2021. Neurotrauma Society of India. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (

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