United Brachial Plexus Network, Inc.

Hello everyone,

I have a left OBPI injury and am scheduled to have mod quad surgery the first week of December with Dr. Nath. I was just wondering, for those of you who have recently had this done, how was the experience (i.e.-pain, discomfort, strength, movement recovery time, etc.) and what were your gains as far as range of motion.- I realize that everyone's limitiations are different.

Thanks,
Joe

Joe
I had surgery in June and although not called a mod quad where I am, what I had done was similar.
Pec & subscap lengthening
Lat & Teres Transfer
Partial anterior capsule release
Removal of 4cm of bone from coracoid/scapula

I am 35 years old and only wish I knew about the possibilities of secondary surgeries earlier. The improvement has been fantastic.

In order or your questions:
- Pain - typical for any surgery. Majority of my pain now comes from elbow, I assume due to differing movement forces
- Discomfort - this varies and I am still trying to get used to position of arm at rest/sleeping. Discomfort, although not consistent occurs quite frequently, but is a small price to pay. I am pushing it daily with exercise and new movements so this is just part of the process I think.
- Strength - Significant reduction in strength for internal rotation as part of pec removed and Lat/Teres now assisting external rotation. I am working on it but I don't think I will ever regain full internal strength - again a small price to pay.
- Movement Recovery Time - This is ongoing and I am confident that it will continue to improve. I was in cast for 6 weeks and it has been approx 3 months since that time. External passive range becoming looser but more controlled. Internal passive range increasing back to pre-op range (I have been nervous about active stretching to internal position - due to the fear of hearing a snap!).
- Gains in Range of Motion - Here is where all the positives are. Passive range now almost as good as good arm (limited by joint itself/bone overgrowth and muscle tightness previously).
Active range - external rotation from absolutely nothing to very good functional range - can eat/drink using bpi arm, hand on head, etc where I could not previously. I can lift arm well above head (with a little cheating). Don't know in terms of degree improvement although certainly enough to reach the top shelves (whereas less than 90 degrees previously).

Another positive is that due to increased range and relocation of tendons, other muscles that weren't utilised previously, inc rear and lateral deltiod are now co-contracting and starting to do some (minor) work - and I am certain improvements will continue. Also due to new position (not as inwardly rotated) there are other excercises I can now do more easily including bicep & tricep work and I am starting to notice significant growth & strength improvement (relative of course).

I actually find that I now have to keep reminding myself to use it. Eg to eat, drink, get things off high shelves, etc. 35 years of favouring one arm is a hard thing to ignore (I even still, without thinking, lift my bpi arm in the shower with the other arm or hold it against the wall above my head and then realise I don't need to anymore).

As I have only posted a few times and this is my first Post-Op, I just want to thank all those that contribute as without the information I found on this web site, I would not have chased up surgeons around the country to take a chance and do the surgery (in general, seems to be more conservative approach over here).

I hope this helps.

Best Regards

Glen

Glen
I am so happy for you. I can just imagine how wonderful all these gains feel. I think these gains will perhaps prevent some of the secondary conditions I have because of the change in your posture and ability to use both hands.

Thanks so much for sharing all of this information.
Kath

Joe,

Hey! I am a patient of Dr Nath. First of all let me say that he is awesome. I had the mod quad 14 months ago. I really felt like my arm wasn't so tight anymore. It did help me as far as my ROM.

I had the humeral osteotomy in 2/04 & wore an Ilizarov Fixator for 27 weeks. Now, that was an experience!!

I just turned 33 & wish so much that I knew of Dr Nath several years back. I would go through everything again if I had to because I have gained a lot.

As far as the pain it wasn't that bad. I had a pillow type sling that I wore for 3 weeks. After that I wore it for 3 months at night.

Physical therapy is a must.

Good luck!!

Good Luck to you and your upcoming surgery. You will be 100% amazed at the results. You are in the best of hands with Dr. Nath. I had my mod quad last September and found to results to be outstanding. I have gained 2 inches in length back. Although I cannot suppinate all the way it really has made a huge difference. I still get a lot of pains here and there, but you truly will like the outcome. Please keep in touch and let us know how it turns out for you.
Best of luck
If you have any other questions please ask.

Glen
Could I ask where you had your surgery? I'm interested in the coracoid reduction. If your doctor is one who publishes results (fingers crossed) I might find something out about it to help my decision on this one. Thanks.

I had the mod/quad done in April of this year. Pain was really nothing more than you would expect from any surgery. The splint was very uncomfortable, especially sleeping in it. My range of motion is much better although well less than normal. But now I can do many self care things I could only do one handed before, or had to get help for. I do have a good sized bone spur in my BPI shoulder though. Dr Shenaq wants to take care of that this Fall.