United Brachial Plexus Network, Inc.

My son Darren, soon to be a young 13 years of age, has obstetric brachial plexis palsy. We have had a few procedures, one at the Texas Children's Hospital when he was 2 (exploratory, cleanup), the other at Shriners in Sacramento when he was about 4 or 5 (muscle transfer).

I've administered loads of physical therapy, and he's go the use of all fingers, his shoulder, but holds his hand in the "dumb waiter" position (internal rotation). Ironically, his favorite sport is basketball... but he does really well and has compensated for his handicap.

I was told years ago that by age 13 he would be a candidate for either an osteotomy or capsulorraphy (triangle tilt) operation.

Of course I'm going to be calling around and gathering information, but I wondered whether anyone here has had experience first hand or indirectly with either procedure.

My chief concern is that either procedure would lead to a loss in function, of course.

Thanks in advance!

If I remember correctly, the triangle tilt operation is not done on children older than 12.

you can do the triangular tilt over 12 but the best results have been in younger patients, to be sure, speak with Dr Nath, he is very forth coming with the results, and will not do the procedure, if he didnt think there would be positive outcomes.

This is what I understood as well regarding the tilt procedure... but my son is not a strapping 13 year older stuck in the body of a 17 year older... he is more like 10-11 years in terms of physical development. I guess I'll get in contact with Dr. Nath and see what he says.

Just curious to see which operation has been found to be more "effective" in terms of increasing functionality...

I believe that in some cases both surgeries are done. The triangle tilt is done for the scapular elevation and the osteotomy for the internal rotation if it is not corrected by the derotation of the scapula.

"capsulorraphy"
I never heard of this term. What does it mean?

The triangle tilt i s a surgey Dr. Nath does. However it has been done by him with great success and he has done it on many children older than 12. So the one guest is wrong. You have to figure it like this ....
you are dealing with the bone healing and you basically stop growing at 16 or 18 except your nose, feet and ears. So the earliest you can get it done the better because your bones grow better when you are a youngster

Anon,
I asked Dr. Nath. He said that he has done one triangle tilt on a child who is older than 12. Check your sources or go straight to the doctor before you give incorrect information please.

"Capsulorraphy" is basically the tightening of the shoulder, not "triangle tilt"--my mistake.

Filled out an e-mail form to Dr. Nath, then realized I have to film a series of movements by my son for his office to evaluate.

Both surgeries?!?

I guess the fun is just beginning... I just have to make sure there is neglible of any danger that he'd lose any function he already has, which is substantial, before I have him undergo either.

Ask Dr. Nath himself and he will tell you that he has done this surgery on very few children over the age of 12.