United Brachial Plexus Network, Inc.

Dr. Nath uses a 3D CT scan to determine if you are a candidate for treatment. You can read all about his grading scale and what he calls the Shear Deformity on his website http://www.drnathbrachialplexus.com. Once he saw my daughter's CT scan, he told us that she was not a candidate. She will be having a humeral osteotomy in the fall with another doctor that he referred us to.

The real point here is he may tell alot of the people here that there child needs TT but maybe those whose children don't need it don't frequent here too often. My son had Mod and Primary with Dr. Nath. When he had Mod I let him try it at 14 months, at that time the youngest child ever to have it done. We were living in Texas and he followed this very closely. Now he does it even younger. Dr. Nath does extraordinary work, I think he had the best interest of the children in mind. I know we have a fair share of Dr. Nath supporters and a number that don't really like him. He has done remarkable things with my sons flail arm. My son had nothing !!!! Sometimes, you have to go with your gut, whatever that might be. If you think that your child does not need the surgery, you might choose to wait and see. For us and Mod, our gut was that doing it younger could do nothing but help my son and that is what we went with. If Dr. Nath told us tomorrow my son needed TT then that would be the way it is!!! I don't think I would even think twice. I really love Dr. Nath and the things that he has done for my child and family, he made our life complete by giving my son function. Enough said! Anonymous for legal reasons !

Our daughter had the acriomioplasty in early 2004, so that is what it was called at least then.

The thing is, Dr. Nath recently recommended for the triangle tilt, but I truly question this. All the reasons for having the acromioplasty are the same as why she should have the triangle tilt?!? I thought the acromio was supposed to have fixed these problems. Can't someone please explain why we are having a different surgery suggested for the same set of symptoms? Sorry to sound paranoid... but it is just not making sense to me.

Were were told that our child did need the TT surgery; then we were told by three other very well known BPI specialists in no uncertain terms NOT to have that particular procedure done because it has not been proven successful, there have been no case studies published to prove that this is a good procedure long term. This is a case where you HAVE to do your research and find out for yourself. Everyone who loves this procedure will tell you how great it is, while those who do not love it will tell you how it is not a good thing. Get past the propaganda and look ONLY at the facts. You can only make a truly knowlegdable decision based on the facts. The pros as well as the cons.

Here is the good news: from what I have read and been told, this procedure is helpful until the age of twelve. I am going to sit back for the next few years and see what happens. Who knows this could be a great thing, but I prefer to wait and make sure.

i have taken my child to three different states/ 3 different opinions offered. i have the same worries, everyone says "go with your gut" this REALLY freeks me out b/c i have NO medical experience so how am i really supposed to know what procedure is best? nath suggested mod & tt for us, the reason we have not gone ahead w/ surgery is b/c he is the only doc so far to suggest this. i really feel this is one of the hardest decisions i have EVER made. and for us we would like to hear 2 opinions that are consistant with each other. the most difficult thing for us is when the docs speak out about each other, also, i cannot really understand why there is such a love/hate for nath. it seems that whoever i have talked to either loves him or the complete opposit? i never in my life thought in year 2006 we (my family) would have to make decisions based soley on our "GUT"?????

You hit it on the head for me, mlynn... I HATE the "go with your gut" suggestion as well! I mean, isn't that how I chose my midwife? Isn't that how I've made every other blind decision I've ever made? I like to think I'm a little more informed now than I was before Joshua was born. I *still* would never trust my "gut" on these critical decisions!

I am conservative with my son's care. Why? Because I fundamentally don't trust that any doc knows everything, and because I don't feel confident enough in my medical knowledge or experience to second-guess the doctors. The only thing that gives me any confidence is concensus and proof. We ended up choosing a procedure to address Joshua's elbow flaring and subluxation that was *still* relatively new at the time. The *only* thing that gave me confidence was that there was at the time 5+ years of patients being followed (with good, lasting results) and the "pioneers" of the surgery had successfully convinced two top BPI specialists of the validity of the surgery. More are getting on board.

I have seen so many "versions" of the capsulodesis surgery since we arrived in the BPI scene since spring 2004. Via google you can go back and see all the glowing reports on the capsulodesis when it was done as the sole procedure to correct subluxation (of which Dr. Nath himself says 75% failed) and the acromioplasty (which had an entirely different "explanation" for why it worked, and has since been replaced by the triangle tilt). Every time the results have been "amazing", "fantastic" and "miraculous"...

I have no doubt of the incredible function that can be gained by correcting subluxation, at least temporarily. Our son had ZERO external rotation and abduction before his surgery to correct subluxation. His range was limited to directly in front of him and to about waist level. He had that terrible "crooked elbow" and was internally rotated so far that he couldn't put his thumb in his mouth... only his pinky with his palm facing "out". Simply putting the ball back into the socket made his arm normal in appearance, and gave him incredible function.

The impacts of subluxation and joint malformation are HORRIBLE. The arm simply cannot hang properly or function properly when the glenohumeral joint is messed up. Correcting the subluxation *can* provide incredible results... but what is more important is that the effect *lasts* and that the underlying cause of the subluxation is corrected. I have yet to see any empirical or physiological evidence that manipulating the acromion and clavicle, which aren't even *part* of the glenohumeral joint, will fundamentally change the malformation of the glenoid and humerus which most doctors now believe is the underlying cause of subluxation.

I totally accept that my skepticism could be misplaced. If the long-term results show that this surgery somehow remodels the malformed joints, and prevents recurrent subluxation in the long run, I'll happily "get on board" with it. I'm sure other BPI specialists will also.

Kate

Hello,

My bpi son is 7 now. He has had primary, partial mod, and bicept by both Dr. Shenaq and Dr. Nath. Two years ago, my son was scheduled for Acrim by both. We did not go through with that. Instead we did more swimming. Last year, we saw both and Dr. Nath said that our son was NOT a candidate for TT. We then went to Dr. Shenaq who said he maybe a canadate but Dr. Shenaq is not doing the TT. He sent us to antoher orthopedic at Texas Orthopedic Hospital in Houston. The first question that Dr. asked us was whether Dr. Nath recommended TT. We told him that Dr. Nath said no. That ortho evaluated my son and said that he agreed no TT surgery. My son's shoulder joint is deformed, however, he is very strong in the shoulder and has alot of motion. This ortho felt that my son would loose function if we did TT. He did say that the TT is valuable to kids that have alot less motion. Lastly, he stated that as my son grows yes he may need this surgery but that it would not be done unless he had pain, lost alot of function, or his arm started to turn in position. We stil see Dr. Nath every six months.. still no TT.

he is triangle tilt happy. i was told by a 2nd opinion that if she had it done, it would do more damage than good. the scapula wings because it is compansating another part. if you take that away, she would not be able to lift her arm at all.

GO FOR A 2ND OPINION!!!!!!!!

We had modquad with Dr. Nath. We thought he would say we needed triangle tilt, but he said no. We didn't have acromioplasty or capsulodesis either.