Hi all! Our newly 2 yr old daughter, Anne Michael (ROBPI) had a follow up last week with her BP specialist and we are wanting to bounce some ideas off of our BP friends .
Anne Michael had a nerve transfer May 2012 and has made progress..she is now able to reach above her head past shoulder height! However, since the surgery we have noticed a dramatic increase in scapula winging. When she is doing certain activities it protrudes almost 3 inches off her back The specialist we see has recommended joint mobility therapy, but we haven't found anyone locally (Huntsville, AL) who is willing to do this with such a young child.
A tendon transfer was mentioned as she is still struggling with external rotation and the scapula winging.
I would love to talk to someone who has experienced the tendon transfer to get your thoughts. We are also considering taking her for a 2nd opinion to a different BP clinic and would love to hear who everyone really loves.
Do you mean she had a muscle transfer and now they are talking about a tendon one?
My son had the muscle transfer and tendon releases surgery at 14 months old and I noticed more scapular winging after the surgery, though his range of motion improved greatly (externally and upward... totally worth it). To help with the winging, we alternated between kinestiotaping and estim/nmes . We also increased his crawling activities (helps stabilize that area). The combination really helped slow down the winging and bring that scapula back in.
We see Cincinnati Children's Brachial Plexus Center and have nothing but amazing things to say about them. Top rated, family centered care, multidisciplinary team (so they are looking at all sides...from surgeons to OT's to nurses to PM and R docs).
How long has she been lifting her arm? The majority of winging in BPI comes from the child moving the scapula and humerus "as a unit" in order to obtain range. Getting them to rotate the ball in the socket is one of the hardest things. This because the muscles around the shoulder joint are weak, so the muscles working on the arm are not the best ones for rotating in the socket. They use pec muscles to lift forward and up, trapezius, etc. The muscles that are strong are the ones which manipulate the humerus and scapula as a unit. The muscles which rotate the ball in the socket are weakened by the injury. This means the scapula, which should be the base upon which all shoulder movement happens, is instead basically an "follower" to all movement. Winging will only go away if the child develops the right glenohumeral rhythm around the shoulder joint and thus allows the scapula to go back to its proper role.
E-stim is good. Manually stabilizing their scapula while they reach and use the arm is good. But a big part of the puzzle is whether or not they ever get back enough of the rotator cuff muscles to feel comfortable letting their humerus rotate normally in the socket and keeping the scapula stable.
Now that my son is older (9) and has decided he wants to improve his arm (it's holding him back in Karate) we are focusing more on this. We are doing a combination of e-stim, manual stabilizing and semg (miotrack if you want to search old posts).
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The specialist we see has recommended joint mobility therapy, but we haven't found anyone locally (Huntsville, AL) who is willing to do this with such a young child.