United Brachial Plexus Network, Inc.

I WAS JUST WONDERING IF ANYONE COULD GIVE ME SOME ADVICE FOR MY SON MIKEY... HE CAN'T PUT HIS HAND BEHIND IS BACK.
IS THERE SOMETHING THAT I COULD DO TO HELP HIM????
I AM TRYING TO STAY AWAY FROM SURGERY RIGHT NOW BECAUSE HE'S HAD SO MANY IN THE PAST 6 YRS..... THANKS

first you have to ask your specialist if he's supposed to be able to get his hand behind his back... am saying this because we were told that after the mod quad she would not be able to get her hand behind her back and that it would not be a loss because she couldn't do it anyway

if it's not supposed to be able to go behind, could you be doing damage by trying to get him to do this? I don't know the answer but it's a good question to ask

It could be lack of strength, lack of range, or lack of coordination or a combination of all three.

Can you get your child's arm behind his back passively? Some surgeries can reduce the amount of passive internal rotation. We work intensively on stretches into internal rotation. But that was specifically okayed by our doctor.

Does your child have strong active internal rotation power? Releases and tendon transfers can significantly reduce the amount of active internal rotation power, depending on the strength and recovery of "what is left". Exercising can strengthen what is left, but only to a point.

If your child has good strength and passive range, but still can't get his arm behind his back, it may be that he has incorrect and conflicting muscles activating which prevent this movement. This could be scapula stabilizers not activating properly (behind-the-back internal rotation movement is defeated when the scapula stabilizers allow the scapula to wing). Or shoulder hiking due the scapula elevating muscles. Or any number of wrong motor patterns that can develop with this injury.

With Joshua, it is a combination. His internal rotation range on his BPI side is less than his unaffected side, so he doesn't flex his muscles through their full range. And he compensates for weaker (through surgery and through lack of recovery) internal rotation muscles by using his triceps to adduct and extend his shoulder. This over reliance on the triceps to create part of the movement (bringing the upper arm down and back) means he can't get his arm flexed when it is behind him.

The secret, and we haven't had considerable success at this, is to try to get your child to use the appropriate muscles, and not inappropriate and ineffective ones, in order to create the movement. That will only work if the "proper" muscles actually work and have strength.

The problem with compensation is it is NEVER as productive as the original pattern would have been.

Kate

My son is 7 years old. He had the mod quad when he was 2 years old. He has never been able to get his hand behind his back. We have noticed a little bit of improvement as he has gotten older and he seems to do a little better if we are actively stretching and working on it (which we haven't been doing much recently). But I don't think he will ever be able to put his hand behind his back in a normal way. Sometimes he reaches his right arm back and grabs his left arm and he can get it a little bit behind his back, but that is about all.

Just thought I would give you our experience. Good luck with finding the answers you are searching for.

Connie

JUST WANTED TO SAY THANKS FOR EVEYONES HELP..... I WILL LOOK FUTHER INTO IT WITH THE INFORMATION YOU PROVIDED.
THANKS SO MUCH!!!!!!!!!!!!!!!!!

SORRY FOR THAT MIS-SPELLING IN A HURRY LIKE ALWAYS
THANKS AGAIN

Before Frankie had the mod quad in Nov he could not put his hand behind his back but now he can the surgery loosened his shoulder alot. Mare