United Brachial Plexus Network, Inc.

My daughter Alyssa has had the primary surgery done here in Indiana. We traveled to TCH where she had the mod quad, then a year later, the bicep tendon lengthening. Her elbow seems to have more of a contracture now though. It has been 2 year since she has had any surgeries and her PT released her about not too long after that since she was active in dance in sports and was using her arm quite well at the time, when she gets dressed, she doesn't use her left arm to pull her up pants anymore. We saw Dr. Nath in August at the Brookfield Zoo and he said he would see us in a year and we are in the process of trying to get her a brace from Ruth and the Ark. She is doing cartwheels and playing like all the other kids, but I am worried about the contracture and what can be done about it. We may call too see if Dr. Nath would like for us to send a video in so he can see, but other that that, we are not sure what to do. Any tips or opinion would be greatly appreciated. Thanks in advance.

If she had the bicep lengthening how come her contracture is still present? I am interested in this subject b/c Ella has a small contracture that doesnt seem like it is going away, but I have also been thinking if a lengthening surgery would benefit her. Now after reading this post I assume is doesnt always work? Anyone with info or experience I would love to hear more about it. (Surgery to correct it) Thanks.
~Krista~

It isn't uncommon at all for contractures to return, at least to some degree. We actually decided against the procedure (at least for now) because we were advised by other doctors that they often return, especially if there is a lot of growing to do. I think it also can depend on the cause of the contracture. Hopefully it won't get any worse. Just be sure to keep splinting. Is your child still internally rotated from the shoulder?

Jeanna
Have you thought of having a second opinion about this? Why not ask another team what they feel the best course of action should be. It couldn't hurt, most of them will accept video referrals and I believe it would be in your childs best interests.

Was Alyssa able to fully extend her elbow actively after surgery?

I asked the same question actually and found out that a biceps contracture can return if your child has a major growth spurt - meaning that the bone grows really fast. And when that happens you can try dynamic splinting or if it is really bad, the surgery is redone. I did notice that my child got a slight contracture back and yes she did have a huge growth spurt, everyone notices that almost overnight she is taller! So we are using the ultraflex splint again at night and it's getting stretched out. We'll have to see how it works out from there.

Would it be better to wait until major growth has finished before surgery in that case, and use serial splinting in the meantime? I think some doctors in Europe may do this, anyone know?

Some doctors would certainly say yes since they can often return to some degree a few years down the road. Many others actually don't believe in the procedure at all, at least not unless the contracture is over 30 degrees. Some feel that it results in a slighty weaker bicep once you release it, and that it will not ever have the ability to have the same amount of strength in the long run. You will find a lot of consensus out there if you research it. Some doctors may do things differently and have a different approach or opinion. This is why some people feel multiple opinions are important and asking many, many questions. And on top of that, some feel the contracture may actually have developed for functional purposes and allow the child to use the bicep and give some assistance. Who knows? For us, we have decided against the procedure, but others are pleased with it. Once you put some effort into learning all that you can, following outcomes and getting a few opinions you will find the choice that seems right to you. I don't think people should feel forced to make a decision one way or the other, particularly not with this surgery.

People are never forced to make any decision about any surgery. Everything in life is personal choice.

My kid had a 45 degree contracture and she was very upset by having a bent arm, she ASKED for the surgery and got it. It's been straight ever since and she's been happy about it ever since. It was the easiest procedure she ever had. Biceps were really weak for about a month then gradually grew back to where it was before, probably about 3 months or so. It's the only scar she has that's actually invisible.

Anyone else whose contracture has returned after the biceps lengthening? This is a worry to me and the doctor never mentioned this might happen when we discussed it.