United Brachial Plexus Network, Inc.

I've recently been told by a medical professional that if there is a muscle imbalance and external rotators are showing signs of "firing up", that posterior subluxation can right itself. This doesn't make sense to me but I just wanted to make sure that no one has found this to be true in their experience?

Has anyone's kiddo had muscle imbalance w/posterior subluxation that corrected w/o intervention?

Thanks,

Chrystal

I live in the U.S. and I had this exact same question. I emailed and sent copies of scans to 3 of the U.S. bpi specialists and 3 of the European specialists and the answers were all the same. "no"
I really wished it was different but it wasn't. But even in saying this, my child's issues might be different than your child's issues so it is best to get your own opinions because it may be possible in her circumstances that the answers might be yes.

That is a great question! My PT thinks it is possible so we have been working with our child a lot with therapy and she still is showing signs of impovement and she is 1 year post op from the primary.

We will be going for another scan in September to compare and see if she is less subluxed. I would love to hear if anyone has any sucess with fixing a subluxation.

if there is a muscle imbalance and external rotators are showing signs of "firing up", that posterior subluxation can right itself.

Oh my gosh, you guys, please tell me what you are talking about. I've been out of the loop working on other issues with my daughter. Please call me or write to explain what that question if asking. I do not understand the question, and I want to.
Thank you,
SusanLynn

I think it depends how much malformation of the glenoid there is. I think that recovering external rotation *could* correct subluxation, but only if the geometry of the shoulder joint is fairly normal. But my understanding is that subluxation is nearly always preceded by significant joint changes, not the other way around.

If there is already malformation of the shoulder joint, there is growing evidence that shows that muscle/tendon transfers to restore external rotation *do not* cause the joint to go back to normal, but only "arrest" the malformation process. So I believe its probable that natural recovery of external rotation is also not going to cause the joint to "go back" to normal. Once the joint geometry has been changed, all the muscles act differently. The external rotators, especially, are truly at a biomechanical disadvantage when the glenoid is retroverted (facing backwards). The "lever arms" by which these muscles work are disrupted, and it's doubtful they could ever exert full strength even if they fully recovered.

Kate

Susan, here's more background on why I asked the question. Our son is almost 4 mths old and his doctor was actively looking for signs of posterior subluxation. Her solution of Botox is not a bad one compared to surgery but the idea of injecting Botulism Toxin and casting for month is not comforting. Our doctor is not aggressive as it relates to surgery. We have gotten the opinions on other doctors and have been told everything from try Botox to Botox doesn't work.

We are also hearing different things regarding the ability of the subluxation to resolve itself over time and want to investigate this as intervention of any kind would be nice to avoid.

The key to this approach is TIME. I would love to go this way but there are no guarantees....either way. Botox may or may not work. Proactive therapy and time might not either.

The problem is the my doctor has never seen that. Her experience is that the situation doesn't fix itself.

I am afraid of Botox. I'm afraid of my son being casted for a month. I'm afraid of the idea of loosing function that he has worked so hard to gain but...I'm also afraid of choosing the natural healing route and choosing wrong. We are scheduled for Botox on Friday and as of right now I'm feeling that we will probably go along with it and then when the cast comes off, continue with the therapy that focuses on encourages healing. We hope that the external rotators will become active and will work with the internal rotators at balancing the shoulders.

Chrystal

Chrystal,

I hear you about the fear. Fear of doing the wrong thing, making the wrong decision, doing something when you should have done nothing, or doing nothing when doing something would have worked.

I don't know if this will help, but a long time ago (ok, it seems like forever ago but is really only a year) I resolved myself to the fact that *every decision I make now is probably going to be found "wrong" in the future*!

Meaning, there will be better treatments, better protocols, better surgery, better therapy, better knowledge... someday. Whereas now we wander in the darkness, someday there will be light! (heck, they might even make it so that it doesn't happen in the first place... one can only hope!) But... we can't wait for someday. We have to do the best we can, right now, with this muddle of information, with these conflicting opinions, with no confidence in ourselves, or our doctors, or our ability to choose doctors.

At some point I realized that this life is not about being physically perfect, or having all the advantages a "normal" arm can provide. Life is about learning, and growing the soul. Joshua has a lifetime of learning and growing ahead of him.

I will probably make wrong decisions for him (God knows, my choice in midwives sure stank) but his purpose on this earth is not to have it easy. It is to learn and make the best of his life and become a good person and a good soul. And all I can do to help him with that is do the best I can and love him no matter what. I can ask no more of myself, and you can ask no more of yourself either.

I pray that you will find peace with your own journey, and comfort in your heart that you are doing your best, despite all the struggles that lie before you. Your soul, too, is on a journey and this injury is now a part of it.

Kate

Very well said Kate. I'll be rereading that email for awhile.

You are right. I should resolve to do my best and accept that some decision I make will be wrong. That would make things a little more palatable I guess.

Your words are timely and very much appreciated.

You are so right about this being a journey. Thanks for reminding me of that.

Chrystal

I can NEVER read our posts without sheding a tear or 10. Kate, I look at our daughter, now almost 2, and I think she's doing great. It's like I do not even "see" the deformities or delays, etc.

I also fear not doing the right thing, or not doing enough for her. And at the same time, I am certain the Lord throws answers in my face, and I've listened to EVERY one, and acted upon them in her best interest. I feel proactive, and guided, and I believe, with everything that I am, if we follow our hearts, we CANNOT do wrong by our children.

I love all our babies sooooo much.

And Chrystal, you know I love you, and ALWAYS think of you. Prayers go out to everyone EVERY day and night from our house, to all of you.

Make a desicion, and have faith in yourself that you made the right one. Never look back. Enjoy the now.

Hugs for all,
SusanLynn

Wow Kate,

That message was wonderful, so helpful. I think I'll print this out and put it next to my bed to read/remember every day! Thanks.

Lexi (mom to Jason, lobpi, 11 months)