United Brachial Plexus Network, Inc.

Will the trapezius surgeries help with scapular winging by any chance? C Bearly

It actually made the winging worse (in our daughter's case) since the upper fibers of the trapezius are moved from the top of the scapula to the humerus.

This is a very, very, very difficult surgery.

Hi Mica,
My daughter is 9 and having this surgery on Tuesday. I am concerned about additional winging. How old was your daughter when she had the surgery? Who did it and how much worse is it? Do you regret having had the surgery?
Thanks,
Tiffany

Aria had the surgery last December, when she was 3.5. Dr. Kozin did the surgery.

The procedure was extraordinarily painful for Aria - who has a high pain threshold. Please be prepared for that going in, and make sure there is a plan in place in case the morphine does not control your daughter's pain. We were told there would be little to no pain, and that simply was not true for the first 18-20 hours. After that initial period, Tylenol with codeine controlled her pain very well.

Our family really likes Dr. Kozin, and we feel he is an excellent surgeon - however, I am not sure if this surgery was a good decision for our daughter. The recovery period for this surgery is much longer than it is for the lat/teres transfer - so, it's good to be prepared to expect a longer wait to see results. We were not warned of this - in fact, were told she would reach maximum results in about 6 months. It was not until I started to panic when we hit 6 months and she still had not improved that I was told of the 2 year recovery timeframe.

Since your daughter is 9, I expect her recovery will be faster, as she can cognitively participate (and truly understand the importance of) her therapy. While Aria is a fantastic child, and works hard in therapy, no child her age can truly understand why it is important to use her affected arm when it's so much easier to use the other one!

In Aria's case, we had the transfer to increase abduction. Nearly 10 months post op, we still have very little to no abduction. However, I have read studies where people had great results, also. As with most surgeries, I think the recovery is one part what your child has going in and one part what her body/brain does with the transfer.

I know everything I said sounds scary. I hope my response does not frighten you away from the trap transfer, because for some children, it is a fantastic surgery that can give them results no other surgery can. Your daughter might be one of those kids who have extraordinary results!

A lot of her recovery might depend on how well her deltoid functions. Aria's middle and posterior deltoid are very weak.

For the winging: Aria's middle and lower trap fibers are not innervated due to a suprascapular to spinal accessory transfer during primary. That eliminated much of her scapular stabilizers. Her rhomboids are weak, so that further impacts her stability. When the upper trap was moved from the top of her scapula to her humerus, that left only her weak rhomboids to stabilize. If your daughter is not in the same situation with her stabilizers, she might not have much of an issue with increased winging. This is certainly something to discuss with her surgeon.

I wish your family great success with this surgery! I hope your daughter gains everything the trap transfer is capable of giving her! She certainly deserves it. All our kids do!

Mica

Where exactly are the scapular stabilizers and rhomboids? C Bearly

Hi Mica,
Thank you so much for sharing your story with me. I need to be prepared for everything - the good and the bad. Dr. Kozin is also doing my daughter's surgery (she has never had surgery before). One of my biggest fears is that my daughter may lose functions. I realize that you haven't seen any new use from your daughter yet but has she lose any function? Was your daughter's surgery considered an upper Trapezius transfer? What you described in regards to pain is very concerning to me. I thank and appreciate your post. It allows me to make sure that I am better informed. I will be praying for that new movement for your daughter and for all of our children.
Take care,
Tiffany

BTW - my daughter (Amaya) is looking to gain more external rotation...

No problem at all. OBPI parents really have to stick together!

Aria's procedure was an upper trap/levator scap transfer. We were told going in that she would not lose function. That is probably true in the long run, but not in the short run. Coming out of bracing (which your daughter will wear after her cast comes off), Aria lost a TON of internal rotation. She went from being able to touch her belly with wrist flexion to not being able to get her hand even remotely near her belly.

It took us about 6 months of hard work, but she is now able to barely touch her belly, with wrist flexion. Aria's arm hangs awkwardly, now. Rather than hanging at her side, it hangs slightly externally rotated. I'm hoping this will subside. It has drastically reduced since her brace came off.

I would be more than happy to speak with you over the phone, if you'd like. Just e-mail me and let me know where to send my number. Or, if you prefer, I will answer any question you have about the surgery right here on UBPN. Don't worry about asking too many questions. When our kids are heading into surgery, there is no such thing as too many questions!

I really do wish you luck with this procedure! Our family will be praying for you and Aria and I will say a special prayer for your daughter Monday evening.

C Bearly,

This site is good for seeing where muscles are: http://www.exrx.net

http://www.exrx.net/Muscles/Rhomboids.html
http://www.exrx.net/Muscles/TrapeziusLower.html
http://www.exrx.net/Muscles/TrapeziusMiddle.html
http://www.exrx.net/Muscles/TrapeziusUpper.html

Also, if you look under "Movement" on each page, it will show you the specific movements that the muscle is involved in creating. That is also really helpful for showing which movements would be affected by weakness in the muscle.

Kate

Dear Mica,tkirkland,Kate and Camille,
You mothers are sooo awesome and knowledgable! I just am in awe of your courage too. Knowledge is power and Advocacy is your life-time job until your children are tutored to do it for themselves like some teens are now doing. Even if your children do not regain function thru surgeries (it really is a crapshoot),their quality of life is greatly improved because they will always know that you have done everything you could for them, especially when they reach the age to participate in those discussions and decisions too.

YOU bet OBPI Moms are powerful force together...! and there is no such thing as a dumb question anywhere on any forum.

We adults love to answer questions and everyone is welcome to read & post on any message forum. Personally, I have learned alot about our pain management from our TBPI Board.

I will be praying for your daughter on tuesday.

HUgs,
"Gramma" Carolyn J
LOBPI/72