Arm length differences?

[Joanie]

I cannot get accurate measurements by myself, so I would have to guess that my left (affected) arm is 3" to 4" shorter than my right arm. It is also permanently bent at the elbow. I guess this is what is called "elbow contracture." My left shoulder is shorter than my right shoulder, and also slopes more than my right shoulder.

Because of the difference in my shoulders, some clothing doesn't fit quite right. Some clothing cannot be worn, but mostly this is not a problem. Falling bra straps on the left side were a problem for many years, until I found a "bra strap keeper upper" that worked for me.

The difference in length, and the bent elbow, have caused more difficulties. As Kath stated, "In order to use both arms we must keep the unaffected arm restricted to the length of the affected arm." I have to be closer to the steering wheel of a car, so that I can reach it with my left hand as well as my right. If I hold something out with my left arm for someone to take, they usually don't take it, because my arm is not out far enough from my own body for the other person to realize that I'm holding the item out for them to take. If I am holding the item out to them in my left hand, it is because something else is in my right hand, so now I must either tell the person to take that which is in my left hand, or put down the item from my right hand, switch what was in my left hand to my right hand, and then hold it out to them. This makes for awkward situations either way.

I would never buy a side-by-side refrigerator. My girth would never fit "into" one side of the fridge. How else would I be able to put something heavy into the fridge? Picture it. The heavy item needs to be carried with both hands. My left arm cannot extend, so my right arm must not extend. If my body cannot fit into the width of the refrigerator, I cannot put the heavy item in the fridge. I once had to analyze this situation, put it into words, and demonstrate it before a friend of mine, who was shopping for a new refrigerator, understood what my life is like, as far as refrigerators go.

This is also the reason why I have a built in oven, which opens to the side. The oven's at a good height for me, and the door swings out of the way, so that I can "get in there," so to speak, as well as pulling the oven rack out.

There are many ways in which the difference in the length of my arms affects what I am doing and how I'm doing it, but I usually don't consciously think about it. I think that Kath did a wonderful job explaining the situation in her post.

Joanie, LOBPI, 58 years

[Carolyn J]

'Mornin' All,
Kath and Joanie have sure "drawn" a GREAT picture of what living with one arm shorter than the other,..my left is @4" shorter than my right...,is like! I hope some Doctors take note and someone does a research Study on us "Adults With OBPI soon!

I would just add that the damage we women with BPI's did to ourselves carrying around our children,infants and toddlers on our "good hip'(I balanced Scott on my Rt. "Good" side's hip)and most times picked him up with only my "good arm"& now my "good" shoulder has terrific arthritic pain etc...

HUGS all around!,
Carolyn J
LOBPI/68 & Proud of it!
ps...don't eat too much Easter/Holiday candy you guys!!

[ErikOlson]

I went looking for studies of long term effects of BPI, and found a new one which follows the patient group as far as early adulthood (7-20 years, median age 13.) The lead author is Dr. Christina Strömbeck of Astrid Lindgren Children's Hospital (I defy you not to think of Pippi Longstocking now.)

She writes "The present study is, to the authors' knowledge, the longest OBPP follow-up investigation using standardized assessments."

The discussion notes deterioration of forearm function, but no trend in shoulder function (i.e. random)

"Shoulder. Long term outcome in [those with] nerve reconstruction is similar to that of [those without]."

"The most pronounced improvement...for shoulder function occurred in those who were most active in [some] sport."

"Forearm. 45% had an elbow contracture." "As many of 90% had an extension deficit at follow-up." The discussion cites splinting as an aid for that, but discounts surgery and proposes preventive therapy.

There is no mention of the uninjured arm in this study. All data refers to ROM, and differences in forearm length are not mentioned. It did cover daily life activities (dressing, eating, computing) and reported generally successful coping. It's good that the study exists, and I hope that it continues so that it can report the functional issues from overuse that adults deal with.




Citation:

Strombeck C, Remahl S, Krumlinde-Sundholm L, Sejersen T.

Dev Med Child Neurol. 2007 Mar;49(3):198-203
Long-term follow-up of children with obstetric brachial plexus palsy I: functional aspects

Dev Med Child Neurol. 2007 Mar;49(3):204-9.
Long-term follow-up of children with obstetric brachial plexus palsy II: neurophysiological aspects

You can read the abstract on PubMed.gov by typing the article title in the Search box, but the article is not available online. I was able to get the article at school through Ovid.

For future reference, the journal website is http://journals.cambridge.org/action/di ... al?jid=DMC

[ErikOlson]

But see here:

http://diss.kib.ki.se/2006/91-7140-912-2/

It's her report.

The statements about nerve surgery and sports are tricky. She means that *change* over time for those with nerve surgery was similar to those with no surgery, not that the nerve surgery did not help! And there is just not a trend with sports participation, despite some cases of dramatic improvement.

[Mica]

Thank you, all for taking the time to respond to this!!! However, more specifically, I'm confused about WHEN to expect to see differences, if they are going to occur. Since Aria's injury is bilateral, her specialists are not 100% sure there will be differences in length. So, my question is, specifically, whether or not I would see evidence of length discrepency by 8 months of age.

I agree completely that if there are differences in length, it could affect Aria much more than just cosmetically. I believe our daughter is absolutely gorgeous, and in no way believe a shorter arm would minimize her beauty!!! That is not my concern. I simply want to be aware of a potential problem which could cause her pain or further disability in the future.

Did any of you observe differences in length by 8 months, or did they show up later in toddlerhood?

Thank you all, again, for responding to my question. Your posts are so open and detailed, and I'm grateful for your willingness to share and the information you gave!

mica

[cassidysmom]

Hi Mica,

this is Dawn, Cassidys mom. I actually noticed that Cssidys right arm was shorter (not alot) before she had her primary, probably around 7 months however since she had the botox treatments and the primary surgery her arm now seems to be the same length again. I have no idea why this would be, but I was curious about this issue aswell.
PS how is Arias recovery coming?
Dawn

[Mica]

Hi Dawn!!!

So good to hear from you again! I'm glad this issue seems to be resolving for your little Cassidy! It truly seems to cause OBPI victims physical pain!!! This injury just makes me so mad sometimes! I'd give anything on the planet if it could be my arms and not hers!

Aria has been dealing with some pain as her nerves regenerage - sometimes it wakes her up in the night. We've been using massage, warm compresses, cuddling and Infant Motrin with good success. Just yesterday, while Daniel was holding her in his lap, she tried ever so hard to lift her right arm. (I thought of what you had said about Cassidy's trying to lift hers!) Aria only got it about an inch into the air, but our entire family exploded - just celebrating and laughing and clapping! Aria smiled the biggest smile at all the commotion! She thought she was a superstar!

I hope Cassidy is continuing to improve?

mica

[cassidysmom]

Hey Mica,

Cass is doing well, no more improvement to speak of but thankfully she does not seem to be experiencing pain. It's such a long waiting game. How often is Aria seeing Dr Kozin as she recovers? Due to location we don't get to see Cassidy's doctor again until August!
It's hard living so far from her doctor,all the doctors where we live don't really know anything about these injuries, they all told us when Cass was born to wait 6 months to a year to do anything!! unbelievable!
Anyway, talk to you soon.
Dawn

[katep]

Dr. Kozin co-wrote a paper on limb-length discrepancy:

http://www.ncbi.nlm.nih.gov/entrez/quer ... med_docsum

"Summary:

Residual limb shortening is common after obstetric brachial plexus palsy. The exact limb-length discrepancy remains undetermined, and the purpose of this paper is to determine the resultant discrepancy. Twenty-two skeletally immature patients with obstetric brachial plexus palsies were examined. Radiographs of both the involved and uninvolved humerii and forearms were obtained with a radiographic ruler placed adjacent to the extremity. Each limb segment was measured and the discrepancy calculated as a percentage compared with the normal side. Twenty-one of the 22 children had some shortening of the limb at both the humerus and forearm level. The involved limb averaged 92% of the uninvolved limb. The humeral length averaged 93% and the forearm length averaged 90%. Children with upper brachial plexus lesions had significantly less forearm and total limb shortening compared with those with global lesions. There was no correlation between age and percentage difference of the humeral, forearm, and total length."

Although these kids are older (range 4-16 years, average 8.6 years) I've seen several severely injured children in the range of 9-12 months where you can clearly see not only are the upper and lower arms shorter, but the hand is smaller and also the scapula on the affected side. If there was going to be a significant difference in length and size, I think you would definitely expect to see it by 1 year of age.

Also, while the summary above reports average differences, the data in the paper shows a WIDE range of limb length differences. I have the paper; if you want to look at it, email me.

Kate

[Joanie]

I'm not a doctor, but I don't think there would be any difference in length after only eight months. The difference in length comes from the affected arm not growing as much as the unaffected arm. This takes time. I don't know how long.

A picture of my siblings and myself, taken when I was two or three, shows no apparent difference in the length of my arms. That could be because of my pose. My hands were on a child's baseball or softball bat (possibly my brother's) which I was holding in front of me, vertically, with the handle end up and the other end on the ground. My right hand was on the end of the bat. My left (injured) hand was just below my right hand.

A junior high school (grades 7-9) picture of me with my arms down shows a definite difference in the length of my arms.

Obviously, I cannot predict what will happen to Aria as she ages. I understand your anxiety for her, but all I can say is, "Only time will tell." Sorry I can't help you more than that.

Joanie