United Brachial Plexus Network, Inc.

Can anyone share with me their experience with resolving a high held elbow. My daughter gets her hand to her mouth but goes up pretty high. We are trying to pin things down a bit but to no avail yet. Any suggestions or experience. I have heard from folks with tendon transfers or an anterior capsule release this can be improved, with residual effects often being a training or bad habit issue as the child ages. Any help would be greatly appreciated.

My sons pt had us tie his arm down while he was eating in his highchair with one of those big rubber band things used in therapy so that he could still feed himself but not put his arm up the air. we also had to use ace bandages severel times a day to tie his arm to his body so that he could still bend his elbow but no arm in the air. But no surgery was needed. Hope this helps.

My understanding is that there is a natural progression of high elbow position to low as more function returns.
First motion elbow high with back of hand to mouth
As supination is gained, the elbow will come down.

Our 19 month old daughter has mastered neutral (so her PT tells us) and we have seen as much as 90% supination at times, her elbow is now much closer to her side when she eats, still sticks out slightly when holding a sippy cup.

In my child's case, it was the anterior capsule release that significantly helped with resolving the elbow up posturing. It was actually one of the reasons I decided to go with this particular surgery. After speaking to many parents and researching different options, we felt that this particular procedure would best resolve our son's internal rotation contracture and subluxation, which led to much elbow up posturing, especially when trying to get his hand to his mouth.

It has been over two years post surgery and the results are holding and still amaze us. He did regress some about 6 months post surgery, and started to posture a little, mainly when hand to mouth, but even then it is minimal and has remained down by about 75-90%, depending on the activity, how tired he might be, etc.

I certainly believe that part of the posturing can entail deeply engrained habits and established movement patterns. However, I believe that anatomical reasons account for the posturing in many children, and only surgeries that truly address the internal rotation contractures, subluxation, etc., will result in change over the long haul. Reminding children or physically holding down the elbow, therapy, etc., may help, but if the posturing is also related to internal rotation contractures and subluxation, I think true progress would be very difficult, since it seems the basic structural anatomy and physical ability would need to support it. Just my thoughts and experiences. We all know nothing is written in stone with this injury.

Good luck in resolving this or making some significant improvement! It is not an easy one in our kiddos.

Lisa