Re: Bobbi does nees caps surg...advice?
Posted: Mon Mar 24, 2003 7:45 pm
If you follow the kids who have had these 2 different types of procedures the results "seem" to indicate that the anterior capsule does need to be addressed. Those with the anterior release appear to not have continued issues with internal rotation, which is often not the case with mod quad or traditional release/transfer procedures. And because of the increased external rotation and the humeral head being in a more natural position, they also appear to be getting more supination back. Of course, the improvement in supination is for the kids who lacked supination more to internal rotation and lack of proper placement of the humeral head than those who lacked supination purely due to bicep/supinator strength.
As I mentioned earlier, this capsule release is often combined with a muscle transfer, sometimes without. It is often used in place of the mod quad or other traditional type muscle surgeries, although the transfer part remains the same (the teres major and lats) and this cannot be done arthroscopically. Some kids have it done in place of those surgeries AND also to address the shoulder joint issue at the same time, so if it works it can cover 2 surgeries or more. I know some kids have already had mod quad or other muscle surgeries elsewhere and have then had just an anterior capsule release done to address the dislocation/subluxing. If you think about it, how many kids are still internally rotated and/or subluxing after secondary muscle surgeries. Why? Where is that coming from? Wonder if others would say it is the laxity of the posterior part of the capsule that is causing internal rotation? I have always been struck how often these surgeries, at many hospitals, don't often fully address the internal rotation issues. I am HOPING that this procedure will take us a big step closer to finding the answer.
As I mentioned earlier, this capsule release is often combined with a muscle transfer, sometimes without. It is often used in place of the mod quad or other traditional type muscle surgeries, although the transfer part remains the same (the teres major and lats) and this cannot be done arthroscopically. Some kids have it done in place of those surgeries AND also to address the shoulder joint issue at the same time, so if it works it can cover 2 surgeries or more. I know some kids have already had mod quad or other muscle surgeries elsewhere and have then had just an anterior capsule release done to address the dislocation/subluxing. If you think about it, how many kids are still internally rotated and/or subluxing after secondary muscle surgeries. Why? Where is that coming from? Wonder if others would say it is the laxity of the posterior part of the capsule that is causing internal rotation? I have always been struck how often these surgeries, at many hospitals, don't often fully address the internal rotation issues. I am HOPING that this procedure will take us a big step closer to finding the answer.