surgery for elbow contractures

[katep]

Null,

You said "We have 3 opinions that said that even if biceps are the slightest bit stronger than the triceps then a contracture forms."

There is plenty of evidence against this conclusion from the experience of spinal cord injured patients.

Spinal cord injury at C5 or below results in weakened or paralyzed triceps while still leaving some or complete biceps function. If it were purely a matter of biceps being stronger than triceps, these patients would all have biceps contractures. They don't.

I think you are right about not being able to generalize. There is clearly a lot of different effects going on here, far beyond just whether or not biceps are stronger than triceps.

Also, regarding e-stim on the triceps. I have a reference from spinal cord injured research that suggests that e-stim on the long head of the triceps is a bad idea if the shoulder joint is not stable. This is because that particular triceps muscle attaches to the shoulder blade, and e-stim can cause it to pull the shoulder out of place if there isn't sufficient abductor/stabilizer muscles to support the load. Feel free to write and I can send you the paper.

Kate

[admin]

Spinal cord injuries and brachial plexus injuries are different. Although some facts and treatments are similar, healing as well as many other aspects, are very different. Let's all keep that in mind.

[Kath]

Guest
I am confused by your statement on spinal cord not being part of this injury. If our nerves come from the spinal cord and you have an avulsion then the spinal cord is injured right? I am just trying to understand your statement.
I am robpi and my spine is affected by this injury and now I have spinal compression all of this would not be a problem if I had not had bpi to begin with. At least that is my understanding.
I am OBPI and it is not just my arm even my leg on OBPI side has poor circulation and is smaller - not shorter but smaller. Its the entire right side of my body. I just assumed that this is part of a spinal cord injury.

Can you explain why bpi and spinal cord injuries are considered different
thank,
Kath

[admin]

Kath,
I am sorry that I was not clear with what I was trying to say. I am talking about spinal cord injuries that are not related to BPI. I am talking about how injuries to the spinal cord alone greatly differ from injuries related to the brachial plexus alone. Sorry again for the confusion.

[Kath]

Thank You Rich and Guest

I appreciate your responses. Now I understand what you were saying and there is a big difference.
Kath

[katep]

Guest,

Of course they are not identical injuries. However, the various branches of medicine can and do provide insight and information. There is a lot of information that has come out of cerebral palsy research, for instance, that has benefitted the treatment of BPI. The use of botox to treat contractures is one.

The experiences of tetraplegics can also aid understanding of what happens when various muscle groups are paralyzed. No, the nerve cannot grow back like it sometimes can in BPI. But the effects downstream are very similar, especially in the case of severe rupture or root avulsion.

Kate

[katep]

Here's the paper discussing functional e-stim for triceps weakness in spinal cord injured:

http://www.vard.org/jour/03/40/6/Memberg.html

The key point, which I think would also apply to kids with BPI, is mentioned in the abstract:

"Stimulation of the long head of the triceps should be avoided in persons with weak shoulder abduction, since the long head adducts the shoulder and limits shoulder function in these cases."

Kate

[admin]

Kate,
I definately agree with you when you say that other branches of medicine help to provide information and insight. I don't think anyone would disagree with that. However, most research is based on a specific "type" of injury and healing process, and a BPI can vary so much from child to child, so imagine how much it can vary from other injuries, diseases, etc. Just look at all the different posts on this site and you will see how differently each child heals and how different each injury is. Also, I think research is great, as long as it is based on true facts and experience. To follow your example with Botox, it works great on CP kids and has for several years, and even on SOME BPI kids, but the research is beginning to show that Botox is NOT generally effective in MOST cases of BPI and with most muscles involved with a BPI. So I guess my point is, each injury and disease is specific, and research from one injury cannot always be applied to cases of a completely different injury, especially when each BPI itself varies so greatly. I hope this makes sense.

[admin]

Kate, I should have been more specific. When I said that we were e-stimming the triceps, I should have told you what type of e-stim. We are doing TES which is way different than NMES because it's only increasing circulation - the electrodes go on motor fields and not motor points and you are working at a threshhold level (muscles do not contract with TES).