United Brachial Plexus Network, Inc.

Amy has made a good point here. Let me clarify my posts so you know what type of transfer my daughter had. (At the same time as the shoulder work.)

Ella had her latissimus dorsi transfered to the shoulder region. This type of transfer, in my opinion, was better to have done at an early age. An age when the child stops recovery, or when the child shows signs of problems or weaknesses that will not improve. These issues can be discussed with the child's specialist to determine when and if surgery is the correct choice. As I posted previously, Ella was 2 years and 4 months old at the time of her surgery.
Below I will write a few sentences out of Outreach to hopefully help you understand this whole (tendon transfer as Ella had) situation better.

ISSUE #15 PAGE 14

"THE GOAL IN THIS TYPE OF SURGERY IS TO RESTORE PARALYZED FUNCTION. INSTEAD OF ATTEMPTING TO REANIMATE PARALYZED MUSCLES BY REPAIRING NERVES VIA MICROSURGERY, MUSCLES ARE TRANSFERRED FROM ONE LOCATION TO ANOTHER, THEREBY CHANGING THE MUSCLE'S FUNCTION. FOR EXAMPLE, A MUSCLE THAT IS TYPICALLY SPARED IN BRACHIAL PLEXUS BIRTH PALSY, THE LATISSIMUS DORSI, IS IN PART RESPONSIBLE FOR THE INTERNAL ROTATION/ADDUCTION CONTRACTURE OF THE SHOULDER. THIS MUSCLE CAN BE RELEASED FROM ITS TYPICAL LOCATION IN THE UPPER ARM, AND RE-ATTACHED ON THE UPPER/OUTER PART OF THE SHOULDER. THE RESULT IS THAT WHEN THE CHILD STIMULATES THE MUSCLES TO CONTRACT, IT WILL NOW ELEVATE AND EXTERNALLY ROTATE THE SHOULDER, INSTEAD OF INTERNALLY ROTATING AND ADDUCTING THE SHOULDER."

Hope this helps you understand this a little better.
~Krista~

The tendon transfers that were discussed were in Sydnees shoulder. I do have a appt. here in Utah with Dr. Murphy at Primary Childrens Medical Center in April. (Anyone from Utah? I have had a heck of a time finding a Doctor that is familiar with BPI's) I will have to ask her more detailed questions regarding this procedure. I do have another question for anyone that might know... I really don't know how to explain it but I will try my best. Syds right arm is never to the side of her body it is always bent at the elbow and up in the air... It'a almost like this is her normal position for her arm, she can put it down to her side but eventually she will have it right back up in that position. Does this sound familiar to anybody out there? How is something like this corrected? Is it ever? Should I worry about this? It doesn't bother me too much but I do have other people comment on it.

Cara

Thanks Krista... Is this the only surgery Ella has had to have?

syds mom,
My son holds his arm the same way , we were told that the tendon transfer would correct that. He does have full range, but no external rotation, he doesn't have full supination but I think his recovery has been amazing with no surgery's. We did try botox in Nov. but I really did not see a difference. We see Dr. Scott Kozin in Philadelphia. I think he is amazing.

syds mom,
My son holds his arm the same way , we were told that the tendon transfer would correct that. He does have full range, but no external rotation, he doesn't have full supination but I think his recovery has been amazing with no surgery's. We did try botox in Nov. but I really did not see a difference. We see Dr. Scott Kozin in Philadelphia. I think he is amazing.

Cara,

I heard that being referred to as "posturing." My son Evan, 2 yrs old, does it, too. I think it's a position that feels natural to him but to most it looks very unnatural - especially when he's running. People ask why he does that. My concern with it is that if he doesn't bring his arm down next to his body (shoulder adduction), he will loose the ability to do so due to contractures.

Thank you for posting this question about tendon transfers. This may be in Evan's future, too. I would love to hear from the people who have experience with this, if shoulder tendon transfers result in internal rotation weakness. Does it help with supination, too?

Yes, it is the only surgery she has ever had. Hopefully and likely it is also the last.

~Krista~

Just an FYI, the mod quad is not the same as the Hoffer Procedure. Here is what Dr. Nath wrote on his site about it:

http://www.drnathbrachialplexus.com/sur ... d_faqs.asp

Is this the same surgery called the “L'Episcopo procedure” and/or the “Hoffer procedure” and if not how do they differ? back to top

No. Both the L'Episcopo procedure and the Hoffer procedure result in excessive external rotation and loss of abduction. The mod quad is designed to minimize changes in external rotation and abduction.

You are describing Sydnee to a "T"! When she runs it is the most noticible. Me, I thin it's cute, but others do tend to notice that more. Has Evan had any surgerys for his BPI. And don't think I'm dumb but what are contractures? Is it when the muscles kind of stiffen up?
Cara

Of course I don't think it's a dumb question. There are many of us here still learning thanks to UBPN and all the wonderful members who give so much of their time to answer questions. My understanding of a contracture is that when the muscles are not extended (lengthened) to their end-range (as far as they can go) and stay flexed (shortened) over time, they lose the ability to lengthen. So it is basically due to muscle tightness but tends to be more permanent. I include holding Evan's arm down to his side as a part of his stretching. By the way, fairly recently there was a post about Reciprocal Arm Swinging you may want to read.