United Brachial Plexus Network, Inc.

Michael had the Mod Quad in May and prior to MQ, his hand/arm was interally rotated quite a bit. Post MQ (4 months now) his hand is pretty much at neutral (has been since the splint came off). He doesn't have any suppination at all.

I am thrilled because he can do things now that he couldn't prior to MQ (for instance, he started clapping using *two hands* this weekend. He has never done that before. Before, he just hit his right arm with his left hand (ROBPI, obviously!) His clapping is a little odd...he kind of cocks his right hand up and claps with his left - but he's using 2 hands! I'll happily take it!)

My husband, on the other hand, is incredibly concerned because he doesn't suppinate. He was so impressed with the results of the MQ (the results are *fabulous*! Even Michael's therapists keep saying that the surgery was definately the right decision), that he is asking me now if there is a surgery to allow him to suppinate. I understand that there is, but I would think (from a few things that I've read here) that he still has time for the suppination to come in - and I also wonder just how necessary it is....IYKWIM. How much does he need to do things like open a door, etc?

Thanks for any thoughts.

Sally

Jameson has almost no supination....It causes some problems but he manages pretty well. He's 13 and does everything he needs to. Fortunately these kids are masters at compensating soooo...if he can't have supination I'm really happy that his wrist is in a really good position to do the things he has to do...
Good luck to you.
T.

Since it is my left hand that is the bpi and I just gained supination to neutral for the first time from the mod quad, I can tell you some of the things I can now do that I could not do before:

Reach out to give/take change when driving through a drive-through, pull out the toll booth/parking lot ticket, without embarrassing myself by having to get out of the car or toot my horn for assistance.

Open a door by turning the handle with the bpi hand. You might think, well, you can open it with the other hand but how many times are you carrying something? I used to have to put down whatever I had in my hand on the floor, then open the door, hold it open with my body, and then pick up the stuff from the floor.

Hold a blow dryer in one hand and comb your hair with the other.

Turn the lights on in my car (they are on the left side).

These are the things that come to mind immediately.

Nancy

My daughter is 2 years old and same thing. no suppination but started clapping after mod quad. Well kind of clapping, left hand clapping against right fist.

Sally,
I have also wondered the same thing. How old is Michael? My daughter is 20 months old and she had the mod quad in Feb. She is still internally rotated a little bit but for the most part her hand is in the neutral position. She can clap her left hand to her right (affected side), and she can now lift things two handed. Dr. Nath believes that she will need the capsuldosis surgery next summer because her shoulder is dislocating. This may or may not help with supination. We will have to wait and see. But we are thankful for what she can do today!

Sally, that is very exciting that Michael is clapping!! Yeah! He will continue to make progess - that sounds like a big start. The older injured adults can tell you the most about the struggles they have but I also wanted to add the things I've noticed that are difficult for my 10 year old. Brittney also has about neutral supination. I see her mostly struggle when she has something already in her "good" hand and then needs to turn her palm up on her injured hand - like when someone tries to hand her something small in her other hand - like change or a piece of candy or something. (buying ice cream from the ice cream truck and trying to get her quarter back while holding ice cream) Also it's hard for her when she needs two hands palm up underneath something to carry it - like a wet painting or craft, - or trying to paint an object and turn it over to see underneath. She got a splinter in her injured palm the other day..... that gets hard. It's hard when she grabs a cup, picks up the carton of milk - but now needs to turn the cup over to pour in to it. Trying to turn playing cards over or papers - she can pick them up but can't flip them over very easily. It's hard to think off hand of all of the little things daily - but one that seemed to bother her a bit was the day she was trying to give antibiotics to her hamster. She needed to hold her hamster in one hand on it's back (supinate) and squirt antibiotics into it's mouth with the other hand. I'm sorry this is a silly example but I wanted to show how things come up daily that you'd never even think of. She compensates so smoothly that even family and friends don't seem to realize the extra effort it takes her to get some things accomplished - but she does accomplish them - just some things are harder. When she was between four and six she used to clap the way you described - but now she has taught herself to bring her elbow down to her side and claps pretty well. She can also supinate a little further if she holds her elbow in towards her stomach. I think she has learned her own methods of getting things done, but I know that life would be easier for her if she could supinate her injured palm - but it isn't necessary to function, but no surgery is an instant guarantee of function either.
It sure sounds like Michael is making exciting progess, and even if he isn't able to completely supinate he will do just fine - just some things will be more difficult.
Christy

Supination was more of a problem for me once I was a parent and had children to take care of.... I learned to compensate and I do it now with my grandchildren... holding, feeding... holding babies and trying to take change... or using the bottle to feed.... I could only hold the baby on my left arm the right was to weak but without supination it was hard to hold the bottle....

Supination is something everyone takes for granted... keep your hand in netural and try to feed yourself, brush your teeth.... take your change... for me it is my right arm... people want to hand me dishes from the right at dinner.... all of these things required supination....

OBPI made many changes in my life. The one movements I miss the most, is the ability to supinate... It is such a natural part of life....

But I learned to compesate well... but I still wish I could supinate.

Kath

My son had the mod quad when he was 3, he is now 5. We got great results from the mod quad too, but still supination is hard if not at all. I always thought he was no big deal to have supination until my son tried doing baseball this past spring. It broke my heart to see him struggling to get the mitt over to catch a ball. YUP supination is needed for that. He has a left hand injury so he throws with his right and keep the mitt on the left. He used his right hand to help turn the glove over to have it facing up to catch the ball. I keep finding things popping up that supination is needed for. The funny thing with our kids is that they always find a way to compensate, which he did in this situation. They are so amazing.

Max is 3 1/2 and has a little suppination achieved mostly with compensation movement but hey-it works-
He also has a left arm affected and I was glad to see that using a baseball glove(which he LOVES) was so perfect for therapy for him! He loves to stand there and hold the glove out and try and get the ball in there, he likes taking the ball in his right hand(unaffected) and bashing it repeatedly into the gloved (affected) left hand- I think this has been our newest UNtherapy or lifestyle therapy-
How important is anything? I mean its all so relative- We have decided AT THIS POINT that suppination is not really something Max needs or notices particularly- I need to add that he has suppination from a pronated position to the zero point and then probably almost 70 degrees with compensatory movements that he has taught himself to use- and yes we are careful and concerned about compensatory affects on other muscle groups ie wrist(carpel) etc but AT THIS POINT thats what we see in our case-
blessings and happy ROMing

after caps katie was in supination. Now however we see more pronation each day. I see her getting frustrated trying to get soap or shampoo in her injured side, taking candy, etc...I don't think they worry too much about doing the transfers for this until they are little older.

We have that clap too--we all do it now!