Deltoid strength w/no wrist?

[chrystalhurst]

It seems that everything I read about other children's recoveries has shoulder coming in after finger, wrist, then bicep recovery (from the hand up).
Although I know every injury is different, just wanted to ask a question. My son (ROBPI) will be 3 mths old this week and progress is slow but there. I'm grateful.

He can lift his arm out in front and to the side 90 degrees normally and every now and then to 120. He has just started showing hand to mouth against gravity. It's weak and he doesn't hold it there long but I'm assuming that anything where the hand is at the mouth is good enough to show bicep? Tonight, he held it there the longest in a sitting position (20 seconds).

Here's the thing....he still is exhibiting strong ulnar deviation. He still is pretty flexed at the rest and when he does extend it is mainly to the ulnar side.

When he bring his hand to his mouth, he doesn't actually get it in his mouth. The flexing is so bad that he can only get the back of his wrist to his mouth (fingers are still pointed away from the face).

His progress is good I think (I'm just glad to see him moving his arm). His arm/hand mostly just looks deformed because of the way he holds his hand. I was looking for resolution there before we saw any in the bicep or the shoulder.

Anyone else experienced healing in this backward sort of way. Maybe it's not backyard but I thought the injury healed up the spine.

I'm wondering if there is anything else I should be concerned about giving the wrist is still VERY weak.

One other thing. I try to bring the injured hand to mouth when my son is on his back. He is really getting into sucking his fingers on his good arm but when I bring the injured hand to his mouth he scrunches up his face like he doesn't want it.

Anyone experienced this?

Thanks

Chrystal

[admin]

Chrystal,

My daughter still ulnar deviates a little and she is 12 months old. It was worse before but has gotten better over time. Dr. Pape said it is because of her arm position which doesn't allow her to supinate fully therefore she compensates some by ulnar deviating. I think your son has a lot of time for that aspect of his injury to recover more, it just takes time. But I am sure you already know that and are probably sick of hearing about the annoying time factor

Take care
Shellie

[admin]

I could be wrong, but the wrist, hands and fingers and usually the last to heal. In cases were there are no wrist, hand or finger movement the injury is considered quite severe because of the extent of force that was excerted to damage c8-t1 (which is further down the plexus). It sounds like your child is doing great! To have bicep against gravity by 3 months is wonderful. This is generally the deciding factor for a nerve graft. As for ulnar rotation, I'm not sure since we never experienced that problem. We have met other families whose children where doing this, but they all outgrew it. Mention it to your doctor and OT/PT. At 3 months it sounds like he is making great progress, hang in there!

[Steff]

Chrystal,

My son will be 12 weeks old tomorrow and is almost exactly where your son is, except he can't really get his hand to mouth while sitting upright... only while on his back. He bent his elbow about 45 degrees while sitting a few times, but that's it. He also does a pretty good job of wrist extension with finger extension, but does ulnar deviate when he's trying hard to grasp or when he extends his arm (no problem with triceps). He keeps his wrist in neutral when at rest usually. His ulnar gutter splint helps (you asked what that was in a different thread; it is a U shaped splint that runs along the ulnar (pinkie) side of the forearm and wrist to the base of the fingers, and Mason's is held in place by 2 soft straps, one at the wrist and one farther up at mid-forearm.) From what I read the sequence in which your son and mine are healing is about the norm. I will paste some info that I found from Margaret Storment, OT, that you may have already come across:

Recovery of the arm once a brachial plexus injury has occurred is:

Scapula elevation/depression, protraction/retraction 0-3 months
Finger Flexion/Extension 0-3 months
Wrist Flexion/Extension 0-3 months
Shoulder Flexion/Abduction 45-90 degrees 0-4 months
Elbow flexion with arm pronated initially 0-4 months
Elbow Extension 0-5 months
Shoulder Flexion/Abduction 90-160 degrees 4-8 months
Shoulder External Rotation 8-12 months
Supination 10-15 months

This is from the UPBN website. Here is the link to the entire article:
http://ubpn.org/awareness/A2001Rstorment.html