humeral osteotomy

[F-Litz]

"I can do my quick and easy EMG test"

I want to correct something I said above... I referred to my little NMES "trick" this way... and I want to explain it further so no one gets the wrong idea.

We had the darndeset time trying to find Maia's motor points. The therapist we had just didn't know where they were and she especially didn't know where they would be in Maia's arm (because of all the transfers, etc) and I think she was just scared anyway. After 6 trips to her and her still not finding Maia's motor points, another therapist overheard us talking and showed us a quick way to find Maia's motor points.

We took the NMES unit and put the ACTIVE electrode on the palm of my own hand. And then we took INACTIVE electrode and put it on Maia's arm on a muscle that was further away from her head (further down her arm) then the muscle we were testing. Then we turned the unit on and turned it "up" until I felt a prickly sensation in my finger and turned it down until it was very comfortable.

I took my pointer finger and just ran my finger along her muscle and had no reaction. But when I came close to her motor point all of a sudden I felt the prickly sensation again. Once I felt it, I knew I was close, then I tried to pinpoint it . Sometimes that meant that I had to turn it up a little. When I found it, I knew I found it because two things occurred: (1) I had a strong prickly sensation in my finger and hand AND (2) I could feel Maia's muscle rise up a bit under my finger. So that's when I knew I had found the motor point. I put then put the ACTIVE electrode on that very specific spot and that's where we did our e-stim.

It worked every time and was easy and not painful for Maia or scary - to do it that way. It took all the stress out of it.

This is NOT the same as an EMG machine. Feeling her muscle rise just meant that this muscle was indeed innervated - connected to a live nerve but that's it. It was not going to tell me how good that connection was or how strong the muscle was... except that stronger muscles would have jumped higher and more easily I guess. And if the muscle is not innervated, then the muscle wouldn't rise up at all.

An EMG machine will give you an exact chart of what is exactly going through that muscle. So you can glean a lot more information from an EMG - but they are traumatic because they are sticking needles into the muscle to get that information.

[Carolyn J]

THANK YOU Francine & Kate,
WOW! I understand my body(read muscles etc.) so much better now. I am proof that you are NEVER TOO OLD to learn something about yourself! It all makes sense to me about all this wierdness in my body sometimes...

Francine, BTW, it was suggested to me that I have an EMG even at my age and even tho' that it is too late for me for surgeries now at 68, but I am VERY afraid of those needles! NO one in the Pacific NW knows about Adults with OBPI's at this point, and I don't want to be a guinea pig for someone who never worked on an OBPI Adult.

Hugs all around,
Carolyn J
LOBPI

[Em]

My name is Emily and I'm 17. I have Brachial Plexus Palsy in my right arm from birth. I was scheduled for Triangle Tilt surgery with Dr. Nath on Dec. 14th. My mom called him last Thursday to ask a question about some pre-op testing. The secretary put Dr. Nath on the phone because he said that he needed to speak with her. He told her that after reviewing my CT Scan he didn't feel comfortable performing the surgery. He thought my bones were too thick because I was too old. He suggested a humeral osteotomy by Dr. Davino. When my mom told me the news...you can only imagine how i felt. I've had the surgery date since August and my heart was broken. I didn't even want to hear about another surgery. All I wanted was the triangle tilt. My parents convinced me to look into the humeral osteotomy, so I did. After I spoke with Dr. Nath on Friday I felt a little more comfortable with his decision and his suggestion for the humeral osteotomy, but still not 100% sure that simply externally rotation the humerous would give me the same results as the triangle tilt, like Dr. Nath said. We went ahead and scheduled the osteotomy for the same date, since we already have the plane tickets and the hotel. We also e-mailed Dr. Davino some questions about what the risks and such were for the surgery. His answers were very broad and didn't satisfy me. I just want to know what motion I will lose or gain and what some of the risks are. If anyone has any tips about the surgery or any great stories that might comfort me, feel free to share them.

Thanks,
Emily

[F-Litz]

Hi Emily!

The one thing you have to have a very careful conversation about is what you will gain and what you will lose by having the surgery. So if there is an instrument you play, or a sport you are involved in or something that you have great passion about that you do with your arms, you need to tell Dr. Davino about this and SHOW him HOW you do it so that he can measure your arm doing those things and see if the function you need will still be ok or if it is at risk.

I wish you the best.

Please feel free to email me.
franlitz@gmail.com

-francine

[Carolyn J]

Emily,
Hello & Welcome! Just a request..to please continue to post here too about you "Journey" and questions thru your upcoming surgery AND your Recovery too. I learn sooo much from everyone's sharing their experiences, questions, thoughts and Gains.

HUGS,
Carolyn J
LOBPI, age 68 & Proud of it!

[hope16_05]

Emily, when I was 18 I saw Dr. Kozin from Shriners at the UBPN camp in 2005, I was hopeful that there were some surgical options for me but all he could uggest was a humeral osteotomy. I then asked him what I would gain and what I would lose. A humeral osteotomy for me would give me pronation (palm down) but the down dide to this is I would lose all my supination(palm up) I would only have the ability to get bach to neutral. For me that loss is too much and I opted not to have that surgery. You really need to ask the losses and expected gains before going ahead with this surgery. I wish you all the best and I am sorry that the surgery you wanted isn't going to work out. But we are too old (sad to think since we are still so young)
Anyway Good luck and I hope to see you posting more often!
Amy 19 years old ROBPI from MN

[hope16_05]

Francine, thats a very tricky way to find a muscle motor point. How do you tell which muscle you are hitting since there are quite a few in the arm? Does Maia's hand show the reaction? Like for me, I am working on finger and wrist extension, but not at the same time, I have two different placements. Thanks for sharing that trick!
Amy 19 ROBPI from MN

[F-Litz]

Hi Amy,

Well we determine which muscle we want to stim, we've only been working on triceps until now...I use my "sneaky" way to find the exact point.

The way to know if you are on the correct muscle is to turn the "volume" up until you get a functional response...meaning - try this on your unaffected arm. Put the electrode on the biceps motor point and slowly turn up the "volume" until the unit is actually making your arm flex. You know you're on biceps when you see the arm flex. So if you are doing wrist extensors, you'll know you're on the right spot when you feel the response under your index finger (if you are using my sneaky way) or if you turn it up you can get the wrist to extend.

And yes - when we're doing stim, Maia's fingers respond- they have tremors. BUT I need to tell you that she gets tremors EVERY time she tries to do any fine motor tasks. Do you get this, too?

[F-Litz]

Amy- here's a book that has motor points and explains the whole thing...

http://www.amazon.com/gp/reader/0812115 ... eader-link

[hope16_05]

Francine, by tremors are you meaning that her fingers twitch? Cant seem to picture tremors tonight.

My fine motor has improved so much just this semester because my student OT is working with me on that. Right now, I am doing one of those stained glass things that you place the little beads in then bake it in the oven. Its taking forever but I have to use a tweasers to getthe little beads where I want them and for the most part, I am only using my right hand. This has increased my fine motor so much! You should try something like that with Maia. It can take weeks but she would make gains from it. You can get them at Walmart I know, I just saw some there two weeks ago. The first time she may only handle a minute or two but keep doing it and she will get much better, I am up to 40 minutes at a time right now, the sad thing is that I am still not finished and I only have one more session

Thats a really good trick for the triceps, I gave up stimming mine because I could never get a good response, maybe I will have my mom help me with this in a couple weeks when I am home for semester break.
Thanks again!
Amy