Pectoral and Trapezius Muscle Transfers for TBPI patient - new member

[Alecia]

Good evening,

My name is Alecia, my husband is Glynn - both near 30. Glynn is Active Duty Navy (10 years). Glynn was involved in a motorcycle accident nearly 2 years ago. He suffered multiple fractures of the shoulder (scapula, clavicle, humeral head was crushed, and humerus)and an upper trunk BP injury. After 4 surgeries to repair the fractures we were finally given a consult to the BP team @ Mayo, Rochester, MN in January 2007. What an AMAZING experience. The team was so positive and came through where the bicep is concerned. Fortunately his hand was never affected, just the shoulder. He underwent the Double Oberlin and C-5 to spinal accessory transfer.

My point in all of this is the strength in his bicep has returned to BETTER than 5/5 (thanks Spinner, Bishop, and Shin), however we still have not seen any deltoid function. He is 18 months post op. (Anyone out there experience Deltoid return? How long did it take??)

So now we are back in MN. We met with the team Wednesday and they are recommending a new procedure we wanted to share.

Due to the orthopedic injury sustained during the trauma and the condition of the humeral head, he will need a hemi-arthsomething which means a partial joint replacement. At rest, the humeral head sits in the glenoid joint very awkwardly as there is only 1 muscle supporting it in the joint. So in comes Dr. Elhassan (another amazing man) who tells us that there are more options. (You can imagine the relief)......
He has scheduled surgery for August 28th (can you believe the BP team is available that soon????) during which he plans to of course do a partial humeral head replacement, but also transfer a part of the pec and 2 pieces of the trap to restore stability!! Apparently this surgery is only recently available/researched/accepted and he can almost guarantee external rotation. What a relief!! Some forward flexion and abduction may come as well through scapula/thoracic movement. Anyone have anything to share on this??
Exciting things going on here at Mayo.
Good luck to all.

[trimommy]

Hi Alecia,
First of all, good luck with everything. The mayo team is beyond awesome!! i had a similar surgery in November 07. oberlin transfer and nerve grafts to restore Bicep and deltoid. My hand was also affected, but i have some use. At 9 months post surgery i am able to bend my arm. However, like your husband, i have no external rotation. I didnt really understand this until recently, so although i can bend my arm, it is not really functional. They discussed the surgery with me at my consult prior to my surgery. They talked about taking part of the trapezius and using that for shoulder stability and the external rotation. Please, please let us know how it turns out! I have an appointment out there on September 9th. you can also email me direct if you would like.

Good luck to you both, i am anxious to hear about the procedure!

thanks,
Robin (boatpr@aol.com)

[brentr6]

This is awesome Alecia, I pray for Glynn's success!! I too am active duty Air Force for 22 years as of last month. I had my motorcycle accident Oct '06. I had Brachial Plexus Reconstructive Surgery Jul '07 with a Gracilis transfer to the bicep. They transfered my nerves from my left Pectoral and attached them to my new bicep and tricep, so of course my pectoral is now paralyzed. I certainly am most interested in the procedure you mentioned. Oh yea, I had the awesome team of Shinn, Bishop, and Spinner as well. What a true blessing that was!! I am due for my fourth post operative checkup Sept 11 at the Mayo in Rochester. I am getting strength returning to my deltoid. Initially I could lift my arm six inches or so and now I can almost lift it parallel to the ground straight out from my shoulder to the side. I still have a considerable subluxation od 1 1/2-2. I'm using the Wilmer Carrying Orthosis brace and it doesn't allow such a tug on the shoulder and I'm certainly trying to wake those muscles up/strengthen them to do a better job. If anyone has any suggestions it wou;d be much appreciated. I do have a response from my new bicep and tricep they're extremely weak as I'm sure you know. I apologize, it's very late, 0200 to be exact and I'm supposed to be in to work at 0500. I'm still having a hard time psychologically with this new way at life. I'm not quite thinking too clearly. I've been AWOL to this board for some time and I need to get back in the groove of regular visits/discussions. Let us know how Glynn is doing and I wish you both god speed!!

[Wes]

Hello my name is Wes, I am wondering if I should go or would be a good candidate to see the Mayo Clinic. I am 4 years past my accident. I can bend my elbow but I have no stability in my shoulder. c5-c6 are pulled out. I have no deltoids or rotator cuff. Question I have for you is what did your husband have that worked verves what did not work and would it pay me to fly out there to see Mayo Clinic. Thank you and Iam happy your husband is doing good.

[Alecia]

Hi Wes,

I am not certain which BPI specialists you have available to you, but Glynn is Active Duty Navy and his docs sent him to what they considered to be the best. At this point in the game, I have to agree.

Glynn had a c-5 stretch injury and the neuroma on C-5 was so large that it was applying pressure on C-6. He had no bicep, brachialis, deltoids, or cuff.

Glynn had 5 orthopaedic surgeries, then the nerve surgery at Mayo. They used the Ulnar nerve and Median nerve and borrowed little pieces of them to power the bicep and brachialis. He has EXCELLENT return on both of those. But, this surgery is typically done very soon after the accident. He also had nerve grafting to the deltoid. Unfortunately the deltoids were too wasted and didn't take.

With the lack of stability in the shoulder... Glynn just had surgery again a week ago at Mayo for this very reason. They used parts of other shoulder muscles to stablize the joint.

I would think that if you aren't seeing results where you are, then it is time for a change. You have to decide for yourself... is the possibility of shoulder movement worth the cost of coming to Mayo? We have found it to be VERY worthwhile. Drs. Shin, Bishop, and Spinner all have excellent bedside manner and explain what options you have and give it to you straight. They have new procedures now too - the muscle and tendon transfers.

I wish you the best!! Keep me posted on what you decide to do!!

Good Luck!
Alecia

[Wes]

Hello Alecia, Thank You very much for all the info. Right now my DR. is at meetings in AZ. and she is good friends with DR. Spinner and is going to talk to him about my case, when he gets there. I am really about how well your husband is doing and all they expect him to get back as far as function. Iam really excited to go out and see what maybe Mayo can do for me if anything, I am hoping they can. Thank you again for all your info and great news about your husband. I wish him the best! And please pass this to your husband A BIG THANK YOU TO HIM FOR KEEPING US SAVE AND FREE! GOD BLESS YOU BOTH!!

[Alecia]

Hi Wes,
Dr. Elhassan has guaranteed Glynn external rotation to about neutral. They also expect him to regain about 45 degrees for both flexion and extension (which is HUGE for him. )
He is doing well. His baseline pain before the surgery was about a 4. Right now he is standing in front of me golfing on the Nintendo Wii and says his pain is a 1-2.
He is having a hard time with one area of skin closing and will probably require a skin graft in the very near future. This is not due to the procedure, but he actually had some very bad skin due to the prior surgeries. We have known for 2 years that this is a problem area. So only time will tell on the bad area...
But I will keep posting as he recovers.

Good luck to you as well, and keep us posted as to your news! I'm sure you'll have options!

Take care!!