United Brachial Plexus Network, Inc.

My daughter had mod quad 5 1/2 years ago and can reach over to her other shoulder (crossing midline) and can reach behind her back. She can sit on her hands (sitting up but leaning back with your hands flat on the ground). These abilities took about two years to come after the mod quad.

Did any of your children have shoulder (bone) surgery after mod quad and if so, what improvements have you seen? Any info. is greatly appreciated!!

My daughter had mod quad 3 years ago at the age of 2. We haven't noticed any function loss. She is able to tuck her shirt in behind her back, cross mid-line and put her hand on her opposite shoulder, put her hands on her hips. She wasn't able to do these prior to surgery on her own. These movements are not as fluid as on her uninjured side, she has to really focus and think through the steps of how to move her arm, but she can do it. She still holds her arm when she runs, we are working on bilateral swinging, and she can get really tight. She can lose pronation quickly if we are not careful.

My daughter did not have a full mod quad though. During surgery the dr. decided that she only needed a partial mod quad, he only "relocated" two muscles.

I think partial releases or partial mod quads can have very different results than many of the procedures being done. It is just always so important to compare similar surgeries. Several of our friends children (who are many years post-surgery)had full or close to full pec releases as part of their mod quads and they were never able to gain hand across chest flat onto heart (like for pledge of allegiance), buttoning up top bottoms, struggle to zip pants, reach across to other shoulder, hand behind back, getting wallet out of pocket, etc., and other midline activities that require a good amount of internal rotation. There are always trade offs to consider with particular surgeries and knowing which kids may or may not later gain such motions is often a true guessing game.

My son had a partial Mod Quad. His Latimus Dorsi and Pectorallis were partial released. He had this done at the same time he had the capsolodesis, and acromioplasty done. He was unable to put his arm behind his back before surgery and cannot still do this. I truelly believe that every child is different, and that each outcome varies. My son has had two surgeries and has only gained from them. He is able to bring his left arm (BPI side) across his chest, as if doing the pledge of allegiance but the oppissite side. Like I said it is hard to compare each child since each injury is different.

Just to add (I'm the guest who posted first about the partial mod quad with no function loss), my child also had a full pec release and can do the behind the back and pledge of alliance...guess it just reiterates that every child is different, and every surgical/non-surgical result is going to be different, and its really impossible to know before hand what you're going to come away with (or not). My child has had no other surgeries.

oops and one more thing (sorry to be a guest doing this too...) we went into the surgery thinking it would be a full mod quad only (no pec release). We did not know until after the surgery that is was a partial mod quad with pec release. The doc explained that once she was opened, they were better able to assess her surgical needs.

Why is is that doctors can change the surgery once they are inside doing the work? I truly hope that you gave the okay for a change and new all things that may or may not happen in the surgery. I for one, would be very upset if I heard a different story once my child was done with surgery. I want to know what is going to be done and that is it. For nerve surgery is may differ due to obvious reasons.

My then four year old child underwent the mod quad 10 months ago, and I am reserving final judgment. She lost motion to her back, which is evidently expected but the doctor didn't inform me of that fact. Her upward reach improvement has been great, and based on the last measurements that is the only area where she has had real improvement -- the others are just a degree or two.

For a long time after recovery she was demonstrating alot of involuntery use of her BPI arm, which I desired for her, but in the past month I see her again using her non-affected arm to asssit her BPI arm.

She has had several significant growth spurts in her height, and most recently I see that the range of motion is still there, but my child's BPI arm is becoming clearly shorter with growth; and her entirely functional hand is dramatically smaller than her non-affected hand. Before the surgery my doctor's assistant forewarned that the surgery would not correct that "signature" of the BPI, that deformity. I ignored him in my hopefulness, but he was actually correct.

In my opinion the mod quad does improve that range of motion, but it does not eliminate that event of short arm.

And, also, post-surgery I was informed that that muscle to perform a chin-up or a monkey-bar reach would be lost as a result of the muscle transfer from there to the other for the benefit of reach...

I posted before that my child had mod quad 5 1/2 years ago and is about to reach her other shoulder to scratch, can zipper and can sit with her arms supporting her body behind her. Just wanted to add that she had a full mod quad with a full pecs release in case you were interested since the discussion about full or partial was ongoing.