United Brachial Plexus Network, Inc.

Hi all, just wandering how to know if a child or adult with an OBPI had any avulsions at birth if you've not gone through surgery. Could some have gotten movement back with the avulsed nerves somehow reconnecting themselves? Maybe the wiring would work a little differently but still work?
Thanks for any input.
Christy

it is my understanding that there is no way to confirm whether the child has an avultion or not without opening him/her up,
...and then there have been reports of avulsed nerves firing during the intraoperational EMGs too-
sooooo
GREAT post
Dont neuromas often conduct nerve impulses...?

I don't know, but would it be safe to say that if the child doesn't fully recover that the nerve was permanently damaged? I often wonder about that.

Patty

or that it didn't reconnect in time to get to a live muscle

permanently damaged does not define the potential for recovery tho-
a nerve that has been damaged permanently can find alternative paths for the firing-

From my understanding (my daughter had 2 avulsions repaired during primary surgery), an avulsed nerve cannot regenerate without surgical intervention. Of course, an avulsion must be confirmed during intraoperative emg because mri's and emg's aren't accurate all the time. I don't think a rupture can repair itself either because the nerve is completely torn. An avulsion is "avulsed"--torn away--from the spinal cord and there would not be any connection from the spinal cord. With a torn nerve--but not ruptured--some innervation may get through the neuroma that forms. I don't know the liklihood of innervation increasing or decreasing over time.

A person with a true avulsion will probably learn to compensate over time because that particular muscle that should have been innervated is not. The muscle imbalances caused by this innervation differentiation can lead to other complications.

The primary surgery that addresses damaged nerves early on in infancy makes that connection while the nerve can still be salvaged. One never knows how successfully the repair or grafting will turn out.

This is a good question for your bpi specialist.

This is a very interesting question.

When I was a child they said " the nerves were torn"
The brace I wore allowed the nerves to grow together again and knit... Now that does not make much sense after all I have read on Erb's Palsy/ OBPI... but I have to wonder. I had no movement the first year at all and they did massage and ROM. I was braced for 11 months... I was just told that I had two different braces by an older brother.

My arm just hung in all the photos. I thought I read about a study on how to do and mri on an adult to see the extent of the birth injury... I lost the link..

It would be interesting to have an mri that would show the extent of the birth injury.

Kath

Kath, that's really interesting that you had no movement in your arm for a year, you can use it some now and move your fingers, right? You've posted before about your Horners, which indicates T1 was damaged (pretty badly if you have Horners still) which would suggest you have a complete bpi, ie Erbs and Klumpkes too, as time has gone by I've realised how bad your injury must be and how well you've recovered, whatever your parents did worked well! You must have some strong healing powers there Kath, you go girl! If you ever do get tests done I'd be really interested to know what they say.

Jenny
I had no movement my Mom said it was like a cold piece of marble when she first touched it at two weeks old. She said it would just drop when lifted -- it just hung there doing nothing but they worked on it constantly. She said no arm or hand movement ... I still remember having to crawl up the wall with my hand. I was pushed to move my fingers. My pinkie and ring finger never got strong. I realize now that every game I played was therapy. I had to take piano lessons and use clay and hang clothes all with arm movement in mind. I was constantly reminded to use my arm use and my hand I was pretty big when I could lift my right (obpi arm up to my neck – using my left to lift ) then I could crawl up the side of my face. My training really helped because my arms have assigned tasks. I am assuming that was the way they got my arm moving. I was allowed to do certain tasks with each hand otherwise I would never remember to use my arm. My shoulder can lift it and I can get my thumb to my face but without supination that is it! It is and awkward movement and useless really. I can’t brush my teeth or comb my hair. My shoulder moves my arm. My wrist moves my hand and that is limited. I was reminded everyday how lucky I was that I was able to move at all. Our family doctor described my injury as severe when we last spoke. He told me that I was lucky to move and it took a lot of hard work to get me moving at all. He always told me not to let anyone mess with it and screw it up; he felt it was a miracle. Now I wonder how many others he saw. I had constant flora scopes and he told me my lungs were weak (Horner’s side effect?) and they would always be weak. He also said I had problems with my diaphragm and I did. He would flora scope me all the time because of all the Bronchitis and Croup and Asthma. I wonder how much he really knew and doctor’s did not share too much information with patients when I was young.

As far as the Horner’s goes I always noticed I had a smaller eye. my Mother in and effort to keep me normal, blamed my eye on my father’s family since it only seemed to show up when I was tired. ... LOL... the eye doctor when I asked him confirmed that my pupil dilates slowly.He also said I have beauty marks behind my right eye? I always knew that my eye did not respond to light properly but no one gave it a name until I noticed that one side of my face was not aging the same (all photos from the right now LOL) that is when I began to ask a lot of questions about my eye and my face and my crooked smile. and finally got the name and the answers... I was scared because I thought I had a mild stroke so glad it was only Horner’s. But I had to point out to the doctor that I did not have symmetry to my face.

I never once and still don’t really think of myself as disabled I’m just different I still think I am lucky I have some use of my arm and hand.

Now I must find the book mark on that page that describes how hard it is to see the initial injury on adult/obpi – or in your case I don’t think they would be able to tell you the same information would they? If you had and mri would it show the same injury as it did when you were first injured? Just curious since you are long term 20 years right? Do you think that nerves have grown and sparked???
Kath

I'm intrigued by these 'old' remedies Kath, did u read the post on the obpi board from the 73 yr old whose nurse applied olive oil and vinegar? She said she never felt 'disabled' either, and you know I don't.

If you have diaphragm problems then that's probably damage to C4, the phrenic nerve. C4 is at the top of the brachial plexus, T1 is at the bottom, looks like you got the whole shebang there Kath! Because you always said you had Erbs I'd assumed yours was an upper plexus injury, your recovery is pretty miraculous you know.

Like you I'd never had an EMG or anything but my injury was monitored by a specialist and surgery was available at that time (1980)although I personally didn't want to go there. By two years I'd had no
recovery so they pretty much wrote me off, but my biceps came back not long after that. I think possibly that nerve regenerated, maybe the others tried and failed, who knows? I suppose an EMG now would just show pretty much nothing, but its interesting that we both got recovery well outside the 'normal' timeframe, I've read lots of articles about obpi now, and although they all have different opinions, an injury like the description of yours as a baby is referred to as severe in all the literature, a book I have here says that if there is not strong grasp reflex at 2 weeks and the limb is atonic and marbled (does that sound like what your Mum described?) it indicates multiple ruptures and avulsions throughout the plexus....so your mum's therapy was wonderful stuff! You adult obpi should get together and compare what your arms were like as babies and children, and how much recovery you all got,to see what actually does happen in an untreated obpi, as you know there's nothing about long term untreated bpi anywhere on the internet. I'd be interested, anyway...And don't you just HATE those papers where the docs say 'Prognosis is poor....' I think 'Hey, that's ME you're talking about! I'm no poor thing, thank you very much! lol!