United Brachial Plexus Network, Inc.

It seems like all of our children who had the mod quad end up needing caps later. I may be totally wrong, but it does seem that all the kids I know who got caps also had the mod quad. Do they tend to go hand in hand, and does it seem like more a matter of time before most of the kids who had mod quad will need caps?

I had originally thought the whole idea of the mod quad surgery was to help align the muscles properly so that the shoulder joint could form properly. I am wondering if so many caps are now being done later, after the mod quad, are they learning that the mod quad really didn't help the joint develop with more stability and that a more normal socket joint isn't forming as well in the long-term to avoid needing caps surgery? Can some of you offer any insight or knowledge?

Also, has anyone out there had the caps surgery without ever having the mod quad? Or has anyone's child had the mod quad done 3 years or so ago and has not yet been told they need the caps surgery?

I've been wondering about this, too. We will be having Caleb's first surgery soon and I'm wondering if I'm just opening a big can of worms by starting down this road. I'm so afraid Caleb's going to end up needing one surgery after the other after the other after the other.

Anyway, sorry, I don't have any answers. We don't even take Caleb to see the TCH people, so I'm not sure what our road will be. But I think that the MQ (or muscle transfer) has been done for a long time now with good results. And I know at least one person who's had the MQ and who's child didn't end up dislocated.

Kari

I have already asked if anyone has not had the MQ and needed the CAPS. Can't seem to get an answer, so I guess I am going to assume it is a surgery that is usually related to the MQ. If someone else has had a different experience I am certainly interested.

There is a HUGE number of children who have had MQ - it's probably up at around 1500 or even more at this point. Caps surgery is only at about 150 from the last time I asked.

My son had the mod quad at age 10 and is 13 now and hasn't had a need for the caps surgery. I think it is more a case of the injury causes the weakness in the shoulder which causes the need for the Caps surgery. I don't think they are related. Different kids with the same injury can have different weaknesses because of the way the nerves grow! Some have hand weakness and others have tricep weakness etc...
Hope this helps...of course this is my opinion.
T.

Also- we tend to use "mod-quad" as a catch-all for all secondary surgeries, and I believe even within these surgeries there are many differences. Some children need more or less work than others - Emily needed releases and lengthenings but not tendon transfers - she was 13 at the time, has not had a problem with dislocation.

Our daughter had mod quad in Feb 2000 at the age of 20 months. She does not need nor will she likely ever need the caps surgery. She is going to go for the bicep lengthening surgery in Dec. Not all kids with mod quad have to have caps surgery.
Kelli

My daughter was scheduled for the Caps surgery. After a lot of research and two different opinions (we're going for a third on Tuesday) we decided at this time we weren't comfortable having the Caps surgery. Many of our questions about the success of the surgery were unable to be answered due to lack of data at this time. Also, some children have had to have this surgery done twice. She's not in any pain at this time and according to the doctors she's seen, she's very functional. However she will be scheduled before year-end to have the Osteotomy, which she probably would of had to have after the Caps surgery anyway.

The opinion of the doctors she's see so far, and from the look of her x-rays, they feel her glenoid capsule is to small (about 1/4 the size it should be) and the chances of the surgery being successful were slim. I asked Dr. Nath about this, and he said they just don't have the data at this time to say whether or not there is a correlation between the size of the glenoid capsule and the success of the surgery.

So on with the Osteotomy, at a later time and with more positive data she can still have the Caps Surgery.
She did have a muscle/tendon transfer two years ago which did help her to gain more function.

I had the mod quad last year , I just had an MRI and they are saying right now, we are OK no need until I grow again and maybe it might change things

My son Josh had the moad quad at age 3. When he was 4 they recommended the caps (which we did not do) and they recommended it again this year at the NY picnic. I am still holding off on the surgery. He's not complaining of pain or seems uncomfortable. I thought the mod quad was it for surgeries, but not so. I am told he will need another surgery someday (caps or whatever), but for now, he's 5 I just want him to enjoy Kindergarten.