United Brachial Plexus Network, Inc.

I dont suppose there have been studies on the harmful effects of the immobilization after surgery on the joints growth/contractures?
Seems to me there are alot of shoulder joint malformation corrections after multiple surgeries-
obviously children with multiple surgeries are the ones more severely injured so therefor could be experiencing more malformation because of injury BUT-
it also seems perfectly logical that damage from immobilization could be hindering normal growth also-
thoughts?

Marymom

I wore a brace for the first 11 months of my life...
This brace strapped around the waist and held my arm in what was called the traffic cop position... My hand was strapped so that my palm faced my ear. This brace was worn 24/7 and only removed for bath and warm olive oil massages and ROM...

It was experimental because in those days the common position was to cast the baby as if just collar bone was broken.... The theory the doctors gave my Mom was it gave the opportunity for the nerves to grow and to heal and some to "knit" together where they had been severed. Since T1 was injured and I was paralyzed totally for almost the first year ... and I could not move my hand to face, etc., we know the injury was severe... Over the years when my Mom said that to people...they scoffed because at that time the theory was that once a nerve was torn, stretched, etc., there was no fixing or growing of that nerve ... but that doctor was (now I know) a man ahead of his time....

As old photos show my arm hung straight down thumb in at the age of 2/3 years. Photos also show that as I matured Contractures formed and my elbow began to stick out and the scapular winging was more pronounced ... my arm no long hung straight...

So immobilization in my case seems to have been a good thing... ...... and if they had not immobilized me I would probably not move today...

The brace was made for me at the cost of $500.00 which was and unbelievable amount 62 years ago ... and no insurance but they would have done anything to see me move... it was made like and old fashion corset with steel enclosed in cloth & leather the inside was velvet and had lots of room for growth... it laced up and the arm was steel covered with velvet and leather with lots of straps and closures to keep my arm and hand in place...it was laced up the front and tied and also had lots of rows of eyelets for growth.... yikes! I never could figure how she got me in and out of that thing.... expecially after I had children... I thought more about it....

The result of long term immobilization has caused me ... no harm.... I do detest any type of restraints ... but I could just be that way and it could have nothing to do with being immobilized for 11 months.

I think most children and adult/obpi will say one of the most annoying things is the fact that we were constantly nagged to move...that to me was the bigest pain along with other trying to teach me to do things their way - or the right way...LOL.... So I guess it never broke my spirit...
Children don't understand and just want to be left alone...LOL....

Just my experience ... don't know if other adult were braced like I was... it would be interesting to find out....
Kath

warm baths,massage and ROMs is a good bit of difference from complete immobilization tho-
those may have been what prevented a good deal of ...what is that word when you get muecle loss because it doesnt move...atrophy, I saw Maxs leg(UNRELATED to bpi- he jumped and broke his leg at 20 mos of age but Im sure I could find a way to relate it to the BPI if I looked hard enough-heck EVERYthing is related to everything else in life)anyways, I saw Maxs leg atrophy in the hard cast big time- they dont use a hard cast on the kids after most surgeries tho do they?
Do they use a cast where you can get in and ROM and massage and stuff?
Kath- your mom sounds very intuitive -

Marymom

I do have atrophy and that was not preventable... for me... I had no formal care after they finished with the brace...just instruction for rom and keep me moving...

I think I would have had atrophy anyway because when the arm is damaged as badly as mine was... the nerve's and veins do not support the muscles and they waste away... as near as I can figure...
when the human body was designed..we all have the same map of veins and muscles and structure ....
when it is damaged -- the arms of a bpi baby no longer follow that grand design and therefore some muscles suffer... there is no map for our bpi arms and each arm is different in the way it heals. And since we have no long term study it is almost impossible to compare...

... so as you know ...

I do believe in intervention to prevent contractures and scar tissue... I do use holistic methods also...but that cannot repair nervers...nor can it cause veins to grow and nourish the muscles...
pt/ot helps with other issues...poor posture... shoulder lifting.... what most people do not realize is that our arms are heavy...so we hold one shoulder high to support them....

simple thoughts on a complex issue...

The children who have permanent and severe injuries get a LOT out of the surgeries. There are plusses and there are minuses to everything. We each make our own decisions based on what we need to do for our children.
And we weather it all and we grow with it all and we make it work.

With all due respect, Marymom - what's this all about? Are you at a place where you need to decide if Max needs a surgery or not?

In my opinion, for what it is worth, the children aren't in an immobilizer for long enough to really cause a contracture are they? O.k., primary surgery, 6 weeks with rom from the elbow down, so not constantly immobilized...modquad, 6 weeks in immobilizer which is completely removeable and rom again to the elbow down...my child is scheduled for capsulodesis now and I understand that it should not be removed, but I don't really think that the immobilization of the affected arm or hand is really going to produce harmful effects, leaving the arm open to injury by not allowing them to heal while in the immobilizer splint is certainly harmful. Blake also had a cock up splint for his wrist when he was a baby and I don't think that it harmed him, as a matter of fact it helped further damage to his weak wrist which is better since his primary surgery. The arm is moving and being stretched and so forth the rest of the time when not in a splint.

OOPS! the cock up splint helped PREVENT further damage to his wrist...guess I need to click the "preview" button next time!!:)

I thought this was an interesting topic. What is the ratio of shoulder malformation, to children that have surgeries? Does shoulder malformation get better over time? How does the shoulder get malformed? As far as atrophy does it get better after a few months past the surgery, with ROM? Call uninformed, but I would like to learn more.
Debbie

You will lose some muscle tissue from being immobilized for a while. And you will gain it back shortly after if you do your therapy. This is common with all kinds of immobilization devices for all kinds of problems.

With the children that go to TCH - because they are in removable types of appliances - have a better chance at NOT having a severe amount of atrophy because many or most of them are instructed to do ROM's even while immobilized. We did it with primary - we did it with mod quad. The only one we are not allowed to do it with is Maia's capsulodesis but that is because of the nature of her surgical repair - many other children having this surgery are instructed to do ROM's.

Shoulder malformation does not come from this temporary immobilization. Shoulder malformation comes from the effects of the injury itself. The shoulder joints don't form correctly because the arm is not moving in full range the way it's supposed to, and therefore the joint may not form in a normal way. Sockets being flatter, humeruses (humeri? lol) being more pointed rather than round. The surgeries give the kids the nerve connection and the range to be able to form a more normalized joint - but even then sometimes it doesn't happen.

They do say however that many children who have surgeries before the age of 3 have some developmental delays and speech delays and we have found this to be true - but we are told that they all catch up eventually. Kind of like what my mother told me - not many people go down the aisle on their wedding day with a binky in their mouths! (she told me this when I was worried about my eldest daughter having a binky at too old an age)



In my husband's and my opionion - what the surgeries do for children that have permanent and severe injuries far outweighs anything else. These children are given a chance that didn't exist years ago - they have a chance to get the movement, to save their joints - it's just an amazing thing. A little muscle atrophy for a few months doesn't scare us at all.

Francine....

Don't forget it may also help prevent secondary injury that many of the adult/obpi are now facing...
That is important to this topic... and you did great for someone who is running on no sleep... and I think my arm is pretty good for 11 month immobilized...that was the course of treatment...
It is the secondary injuries that concern me for untreated bpi... and I am sure it depends on how severe the injury is... but... it is a concern and maybe preventable... and I am not spell checking....LOL... so any mispelled words are a direct result of obpi...LOL
Kath using a good excuse...LOL