Recover elbow movement before shoulder, what does it mean?

[mom2nine]

Hi.

I have 6 week old who had LOBPI. He had wrist and finger movement from birth, although he presented with the typical waiters tip position. He has since regained elbow flexion, but no movemtent in his shoulder. I understand that this is atypical. Has anyone else experienced this? What was your outcome? What could cause this? What does it mean?

Any and all information is appreciated.

Thanks!

[Jane]

mom2nine,

When I saw that you were the mom of 9, I felt compelled to reply since my BPI child was my 7th. I would like to talk to you. Please send me an email at jane.from.ohio@gmail.com

Thanks

Jane

[Jane]

Also, I just bumped up the Femke video for you to watch.

Jane

[katep]

Are you sure that what your child has is actual elbow flexion at this point? Is he sitting up yet or are you seeing this movement while he is lying down? It could be that he is cleverly using gravity to bend his elbow. You need to see it bend against gravity. A good way to see this is to place him on his back and hold his upper arm against the floor while encouraging him to suck his left thumb or bring something to his mouth with his left hand. If he can flex his elbow to lift his forarm off the floor while you hold his upper arm down, then this is biceps against gravity. But if you let him just raise his whole arm up, he might be using pectoral muscles or even deltoids to lift his arm up so that his elbow "falls" into flexion.

The biceps get innervation from both C5 and C6 and the deltoid primarily from only C5. So you are seeing that the C6 is recovering by 6 weeks old (a *very* good sign). It is possible that C5 is more severely injured but I don't think it would be expected to be significantly worse than C6. So if C6 seems to be doing OK I think you have good reason to hope that C5 will recover eventually as well. I don't think it is that unusual to see biceps before deltoids. Our son never got very good deltoid recovery, but he still has really great function and people have a hard time noticing anything wrong unless he really tries to overhead reach for something.

Kate

[johnstrike]

Our BPI specialist told us that it can be really difficult to see if arm flexion is done by a recovering biceps. In the case of Femke there was a team of three specialist discussing wheter her arm flexion was done by her biceps.

Some kids can bend there arm by using muscles from the wrist. I think this is called a Steindler movement. There are operations performend to optimize this movement for people without bicpes.

[mamaofsix]

I also thought my son had elbow flexation. He would bring his arm up to his mouth which had his elbow bent. When our PT saw this she let us know that it was gravity and not biceps. He has strong shoulder movements.

[Jake'smom]

I am confused by how the child could bend his elbow using gravity w/o any shoulder movement? I always thought they lifted their arm at the shoulder and then the arm bent or dropped at the elbow. Maybe this is b/c of which nerves are damaged. Even though it's atypical, we all know what variations there are with this injury. What does the dr or therepist say about it?
Shari

[mom2nine]

Thanks to all of you. The movement that he has is definitely biceps. This has been confirmed by his PT as well as the team of BPI specialists in Cincinnati. He began to regain biceps function around 2 weeks of age and it has improved since then. He can now bend his elbow against gravity to greater than 90 degrees and he often will hold it bent for a while.

We had assumed that he did not need primary nerve surgery based on the fact that he regain elbow so quickly. We were told that if he still has no shoulder in a month that we should discuss the possibility. I was just wondering if anyone else had seen this pattern of recovery and what the outcome was. Does it mean that the injury is more severe than we had originally hoped? or does it just mean that he is doing this his own way? )
Thanks again!

[katep]

Shari,

when lying on his back, Joshua could lift his arm to about 90 degrees with his pec muscles and back arching (no deltoids). He just had to get his hand up high enough and then let it "fall" to his mouth to get elbow flexion.

mom2nine,

Has your son had an MRI of the shoulder done? I've read that (rarely) the shoulder joint can completely dislocate at a very early age, which might explain why no shoulder movement. Although it sounds like your team is on it so this is probably a stupid question

Kate

[katep]

And yes, definitely biceps starting back w/in just 2 weeks but no deltoids at 6 weeks old is definitely pretty unusual. These two parts of the upper trunk (C5 and C6) usually are not THAT different in the amount of damage they encounter! I would not expect C5 to be that bad off since C6 seems to have done so well... so hopefully this means that deltoids and other shoulder are coming soon.

I hope you'll keep us updated on your son's progress!

Kate