United Brachial Plexus Network, Inc.

I know that different doctors splint in different positions after muscle release/transfer surgeries, but what I am really wondering is if anyone knows why TCH doesn't splint after the mod quad when the child is still completely unconscious. I have heard that the splinting process the next day can be a very icky experience. Plus most people say you actually get the best stretch when the child is completely out & totally relaxed, so I am wondering why they wouldn't take advantage & splint then, to get the most range possible.

My son is a very, very active & stubborn guy, and when he doesn't want to cooperate - good luck! I am bummed that TCH doesn't do the final splint until the next day, unlike many others. Does anyone know the rationale? Is there a reason for it, or is it more a coordination/timing issue of having a therapist on hand?

I am just dreading the thought of putting my son through it the day after major surgery, and I feel even worse for the individual who will have to attempt it.

I don't think the issue is the "best" stretch - because getting it to stretch more or at it's "best" can cause nerves to stretch and rupture as well.

I think it's pretty hard to do a splint when the child is unconscious - they need the child sitting up in a "normalized" position to get the chest/abdominal area with the correct circumference. They do a temporary cast/splint but usually that lasts just enough time to do the splint.

If you give your child tylenol before the splinting and bring a favorite movie tape then it should be ok. If not - you can call a Child Life Specialist into the room to help keep your child occupied. We did that last time and actually Maia just wanted to watch her special tape and didn't give the person the time of day...lol.

I've seen people post on each side - some hate the concept of splinting and they choose a doctor that does a cast itself and some love the idea of splinting.

My personal experience with it is that it's a lifesaver for Maia because she has severe skin breakdown underneath it and it allows us the capability of taking it off daily and washing her skin - rehydrating it - gauzing it or whatever we need and putting it back on. We can also wash the splint interior and the foam - which is especially handy if your child has a stomach virus or spills food or something like that.

Also - waiting for the next day is helpful too because she has more wits about her the next day and CAN actually accomodate them doing the splint and we can all give our input about it at the same time (about specifics that might be necessary for her, etc.)

hope this is helpful,
francine

I agree that waiting until the child is conscious is better because with my son they had to modify it because the "best stretch" was way too far for him and caused extreme pain....It is uncomfortable for them but if you ask for pain meds about 20 minutes before you go it's not as bad.
T.

I was nervous about the splinting for mq as well, but it really isn't that big a deal. We gave Juliana some tylenol with codeine, they had a child life specialist there, and it was fine. For biceps lengthening, they had the new splinting room with the tvs and toys, to it was really easy.
I, too, like the splints because they come off. Juliana had a stomach virus during out mq time--I was soooooo glad they gave us extra padding!!!

I found that the most important thing was for the parent who was on arm holding duty be REALLY comfortable. You are holding your child's arm at an angle that they have determined...and if you start to tire...it makes it very difficult. So, get comfy, bring a video, and it is not as bad as you think.

hope it helps,
claudia

I do agree that the new splinting room is just fantastic - this little tv right in the kid's face - perfect...

Elisa - if you want to see a picture of the splinting room/tv look at Maia's capsulodesis page

http://www.injurednewborn.com/maia/capsurgerypics.html

in the middle section you will that little tv and my little mesmerized girl! lol _ I think we brought bob the builder with her...my little tomboy!

Elisa,
I had a more difficult time holding his arm in that position for an hour and a half than Matt did. I liked the idea that I could take it off and wash him. the cornstarch powder they give you kept him dry and refreshed. He would get a little red under the non bpi arm from the splint. As long as we put powder there he was fine. When we put the powder on he went "AAAAHHHH" it was cute. Matthew tends to get hot easily and the ability to keep him powdered really helped out a lot.

Matthew is also active and stubborn - the day after surgery he wanted to be up walking (running) around.

We also gave him a dose of tylenol w/codene in it before we went down to the splinting room.

Cindy

Hi Elisa,
My case manager with our insurance company told me they probably wait until the next day to make sure any swelling has gone down. I would call TCH and ask. It's a very good question.

Allison - you are so RIGHT!!! Maia was SO swollen after each surgery. (The less time under anesthesia the least swollen it seemed, too but it only lasted for a short time)

Thanks so much for all your input.

It still is such a hard scenario to imagine. Hopefully it will go better than I think.

Francine - thanks for the info. Sooo glad there are t.v.'s. The pictures on your site are both heartbreaking and adorable. I got teary looking at what your precious angel had to endure. I LOVE the magic sparkle idea!!!

Cindy - 1 1/2 hours, oh my gosh, now I really can't imagine. Is that the normal time length to splint? Help.....

Is the arm allowed to move at all during that time? Can it come down? If they are fighting how do you get it in the best stretched position?

Thanks again!

Elisa...

1 1/2 hours is normal - could even be more but at least 1 hour...

the arm is NEVER allowed to come down - the parent has to sit behind and hold it up - ESPECIALLY with the caps where a bone positioning is at risk if the arm moves

the time goes by pretty fast with movies, etc.... your child might not be fighting it because he might be scared to move his arm - it will also hurt if he does just a few hours post surgery really

and "best stretch" doesn't apply - it's just a specific position - not a stretch

-francine