United Brachial Plexus Network, Inc.

I am new to this site. My son Eric now 1 year old was born 10 pound 4 ounces and obstained a right brachial plexus palsy. He has a root sleeve tear to C7. He has weak to little tricep, poor wrist and finger extension. However he does have external rotation, but poor internal rotation. Dr. Nath has recommended the mod quad surgery. Does anyone have any experience with him or the surgery?

I've never heard about that particular surgery, however my 2.5 year old son's surgeon said that if he had the surgery, (help extend arm muscle) it would compromise his strength.

As you are new to the site, I want to welcome you. There is a lot of information available to you. We also have a fabulous publication, Outreach, and if you email nancy@ubpn.org, Nancy Birk will send you back copies of Outreach. It really is amazing.

As for the mq, my daughter had it. In and of itself, it is a fine surgery. However, there is also the ACR, which shows a lot of promise as well.

We have a medical resourse page on this website and I thoroughly encourage you to take advantage of it. The doctors numbers and emails are there and they each have answered a questionaire, so you can learn about them. The MOST important thing is to get more than one opinion. Many doctors will take video or dvd evals...as a first step.

good luck and keep asking questions,
claudia

The Mod Quad surgery (other doctors call this surgery tendon transfers or by a variety of names) exchanges internal rotation function for external rotation function. Muscles that act as internal rotators are released and/or transfered to new positions in order to act as external rotators.

If your child already has external rotation, and is weak in internal rotation, that tradeoff makes no sense. I would get more than one opinion.

Kate

WELCOME, as for the MOD QUAD my son had it 6 years ago. When he was 14 1/2 months old. I wouldn't trade it for the world. he gained soooooo much from this surgeries and has required no others than Mod and Primay ! Gayle mom of Brandon robpi

My daughter had a mod quad and got movement we never expected. It was a celebration and a miracle for her. She has no problem zipping, scratching the other shoulder (crossing way past midline) and putting her hand in her back pocket. Please stop disrespecting Dr. Nath and all the good that he has done for so many children and adults.

External rotation is the only thing my son still lacks. He's still only 3 months old, so I want to watch and see how he does with therepy before considering surgery. Do you guys know if the mod quad needs to be done by a certain age? Is it something that could wait a while? I know you guys aren't drs but you've been through all this so I thought you might know. Thanks!
Shari

I know that Dr. Nath likes to Mod Quad earlier than he used to. It used to be aournd age 2 and I know that he does them earlier now, with excellent results. My son had Mod Quad at 14 1/2 months and it too was the miracle surgery !Gayle

2nd Guest,

It is a *fact* that if the child already has weakness in internal rotation, tendon transfers moving internal rotators to external rotators will only further weaken internal rotation. If internal rotation is already weak prior to surgery, it makes no sense to further weaken it.

Yes, some kids come out of MQ/tendon transfers with super function both in external rotation *and* internal rotation. Your child sounds quite lucky. A great many kids who have had MQ/tendon transfers have significant problems with zipping, hand behind the back, crossing midline, etc. These are all important functions, and they can be lost if too much internal rotation strength is sacrificed to obtain external rotation and overhead.

Some parents are now facing humeral osteotomies for *internal rotation* because their children don't have enough internal rotation after these surgeries. Tendon transfers *redistribute* muscle power. Sometimes the recovered muscles are just not strong enough to "cover everything" fully. Sometimes there needs to be acceptance that the recovery is maximized at less than 90 or 100% normal; possibly much less.

The fantastic outcomes from these redistributing surgeries are simply *not* available to every child. The quest for the "holy grail" of external rotation and abduction can result in losses of other functions that are equally (maybe even more) important.

Kate

Jake'smom,

If Jake is only 3 months old and external rotation is all you are lacking, it sounds like he is doing very well. There is no rush on any surgery but primary (which he clearly is not a candidate for). I would hate to see you do a surgery redistributing his muscles and then him get enough recovery that he didn't need it, or worse is then umbalanced in the opposite direction!

Kate