Last week we took Hannah to TCH to have her third surgery- the Caps. She is dislocating and sublexing and Dr. Nath thought that the Caps would be the best bet for her to help her shoulder joint.
BUT, once she was sedated, he realized that her shoulder joint would not tolerate the Caps surgery- that there was some type of malformation in the joint(secondary to this injury) that would prevent him from sucessfully doing the Caps. He mentioned that this happens in about 10% of children.
They did go ahead and lengthen her bicep muscle, but for now, there is nothing they can do to address the actual shoulder joint. Dr. Nath brought in the Orthapedic Dr who looked at Hannah- age 3 and said that her bones need another year-18 months of growth before they will schedule the Osteotmy.
Just wondering if there are others who have had this same experience.
Thanks,
Emily
Not able to do Caps..
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Re: Not able to do Caps..
Emily,
Could you please share which type of malformation it was that made them feel the caps would not work? Do you happen to know?
I haven't really heard of this but maybe others will be able to share. I did have a friend who decided against the caps surgery due to the very small size of the humeral head, but tch was planning on going ahead wiht it. Another doctor recommended not to do it since it would never hold. They ended up going with the second opinion.
Maybe TCH has changed their protocol some???? Just wondering. If it is 10%, hopefully others can share. Sorry you had to go through that but I am glad they didn't just go ahead with it and that they really checked things out. I think that is great!
Could you please share which type of malformation it was that made them feel the caps would not work? Do you happen to know?
I haven't really heard of this but maybe others will be able to share. I did have a friend who decided against the caps surgery due to the very small size of the humeral head, but tch was planning on going ahead wiht it. Another doctor recommended not to do it since it would never hold. They ended up going with the second opinion.
Maybe TCH has changed their protocol some???? Just wondering. If it is 10%, hopefully others can share. Sorry you had to go through that but I am glad they didn't just go ahead with it and that they really checked things out. I think that is great!
Re: Not able to do Caps..
Caps was recommended for Matthew but I didn't agree with the procedure. There are a few bpi docs out there doing an anterior shoulder release which in my opinion addresses the problem instead of skirting around it. I would seek out a second opinion. In recent research I've done about shoulders it's recommended to have surgery done by the age of 4.
Cindy
Cindy
Re: Not able to do Caps..
Emily,
We just had the very same experience at TCH (04/13/03). Matthew was admitted to the hospital, and had been seen by the Resident (actually I think he is a Fellow)who said that he was clearly very dislocated. ( our surgery was moved from Wednesday to Monday at 7:00 a.m., so they said our evaluation, which was supposed to take place at the clinic on Monday afternoon, would just happen at the hospital prior to surgery) They gave Matthew the pre-med to get him groggy before surgery, then Dr. Nath came in to look at him. He felt that Matthew's scapula was not going to be able to support the weight of the humerus once it was put back in the proper place via caps surgery. He showed me what it would look like post caps when the humerus was in the proper place, and Matthew's scapula stuck up over the top of the shoulder about 2 inches, and from the back the scapula was almost perpendicular to his back. It was horrid to see. He felt that stitching the joint in that position would be painful and disfiguring, and ultimately lead to the caps failing since it would be trying to stay in such an unnatural position against opposing forces. I was quite stunned; however I realized that I should have brought Matthew for an in-person evaluation closer to the surgery date. That is one lesson I learned and will not make that mistake again! It was very difficult for me to "shift gears" when we were so close to having it done. But in retrospect, I am glad Dr. Nath was truthful with me. They feel that the osteotomy will be the best avenue for Matthew given his particular scapular weakness. I have to think on that a while! They did do the bicep tendon lengthening, which has been unbelievably easy for Matthew. The only bad moments were when he came out of anaesthesia; they had to knock him out again b/c he was out of control. But when he wokeup a few hours later, he wasn't even in pain and was his sweet self. We left the hospital a day early b/c he was dancing and singing for all the nurses in the hall!
Anyway, I was surprised to see someone else had our same experience. Anyone else out there had that happen?
Cathy
We just had the very same experience at TCH (04/13/03). Matthew was admitted to the hospital, and had been seen by the Resident (actually I think he is a Fellow)who said that he was clearly very dislocated. ( our surgery was moved from Wednesday to Monday at 7:00 a.m., so they said our evaluation, which was supposed to take place at the clinic on Monday afternoon, would just happen at the hospital prior to surgery) They gave Matthew the pre-med to get him groggy before surgery, then Dr. Nath came in to look at him. He felt that Matthew's scapula was not going to be able to support the weight of the humerus once it was put back in the proper place via caps surgery. He showed me what it would look like post caps when the humerus was in the proper place, and Matthew's scapula stuck up over the top of the shoulder about 2 inches, and from the back the scapula was almost perpendicular to his back. It was horrid to see. He felt that stitching the joint in that position would be painful and disfiguring, and ultimately lead to the caps failing since it would be trying to stay in such an unnatural position against opposing forces. I was quite stunned; however I realized that I should have brought Matthew for an in-person evaluation closer to the surgery date. That is one lesson I learned and will not make that mistake again! It was very difficult for me to "shift gears" when we were so close to having it done. But in retrospect, I am glad Dr. Nath was truthful with me. They feel that the osteotomy will be the best avenue for Matthew given his particular scapular weakness. I have to think on that a while! They did do the bicep tendon lengthening, which has been unbelievably easy for Matthew. The only bad moments were when he came out of anaesthesia; they had to knock him out again b/c he was out of control. But when he wokeup a few hours later, he wasn't even in pain and was his sweet self. We left the hospital a day early b/c he was dancing and singing for all the nurses in the hall!
Anyway, I was surprised to see someone else had our same experience. Anyone else out there had that happen?
Cathy
Re: Not able to do Caps..
Cindy,
Just wondering when your son is going to have the anterior shoulder joint release done? Can you share what the doctor said about any scapular weakness and how they would address that from an anterior approach (or do they also tighten the back?)
I know it has been posted that some docs don't believe that the probelm is posterior laxity; however in my child it is an obvious posterior laxity, so I am just wondering how they might approach my Matthew's situation? Thanks for sharing any insights!
Cathy
Just wondering when your son is going to have the anterior shoulder joint release done? Can you share what the doctor said about any scapular weakness and how they would address that from an anterior approach (or do they also tighten the back?)
I know it has been posted that some docs don't believe that the probelm is posterior laxity; however in my child it is an obvious posterior laxity, so I am just wondering how they might approach my Matthew's situation? Thanks for sharing any insights!
Cathy
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Re: Not able to do Caps..
Cathy,
Could you please share how you know the that it is obviously posterior laxity? Is there something that specifically makes it obvious that it is laxity posteriorly, aside from the fact that it is a posterior dislocation?
Just trying to learn and make sense out of things.
Thanks.
Could you please share how you know the that it is obviously posterior laxity? Is there something that specifically makes it obvious that it is laxity posteriorly, aside from the fact that it is a posterior dislocation?
Just trying to learn and make sense out of things.
Thanks.
Re: Not able to do Caps..
Cathy,
The scapular weakness should improve once the humeral head is back in place. They don't tighten the back, it tightens up on it's own after the tightness in the front is addressed. After the front is addressed the shoulder joint is allowed to grow normally instead of remaining tight and pushing the humeral head out the back.
I'm not sure how he would handle your Matthew, but we're now seeing Dr. Kozin at Shriner's. He is great with getting back responses to questions if you email him. If you decide to contact him please let me know how you make out.
Cindy
The scapular weakness should improve once the humeral head is back in place. They don't tighten the back, it tightens up on it's own after the tightness in the front is addressed. After the front is addressed the shoulder joint is allowed to grow normally instead of remaining tight and pushing the humeral head out the back.
I'm not sure how he would handle your Matthew, but we're now seeing Dr. Kozin at Shriner's. He is great with getting back responses to questions if you email him. If you decide to contact him please let me know how you make out.
Cindy
Re: Not able to do Caps..
The scapula is so displaced and unstable that it cannot hold or support the humerus in the proper place. The scapula is severly unstable (not held down against the chest wall) due to injury at the level of the long throacic nerve. Matthew's scapula is almost on his side, not in the mid back area.
What I wonder about is if he would have an anterior release, along with the posterior weakness at the scapula, would that create a completely unstable unit, or would they do something to address the posterior laxity along with the anterior tightness?
Sorry to answer a question with a question, but if anyone knows, I would love to understand this better.
Thanks,
Cathy
What I wonder about is if he would have an anterior release, along with the posterior weakness at the scapula, would that create a completely unstable unit, or would they do something to address the posterior laxity along with the anterior tightness?
Sorry to answer a question with a question, but if anyone knows, I would love to understand this better.
Thanks,
Cathy
Re: Not able to do Caps..
sorry Cindy...I think I was posting my last response when you were posting yours!
I think I will ask him how the scapula tightens itself when the instability comes from nerve damage, and not an orthopedic "chain reaction". Perhaps he has a different take on it... I'm still a little unclear on this. I'll let you know what I hear. Thanks for your response!
Cathy
I think I will ask him how the scapula tightens itself when the instability comes from nerve damage, and not an orthopedic "chain reaction". Perhaps he has a different take on it... I'm still a little unclear on this. I'll let you know what I hear. Thanks for your response!
Cathy
Re: Not able to do Caps..
Cathy,
No problem, if I didn't make so many typos I probably would have posted before you. I hope it made sense but I'm sure Dr. Kozin could explain it better than I ever could. (We're moving in a couple of days and getting ready for trial so there's minimal sleep these days)
Cindy
No problem, if I didn't make so many typos I probably would have posted before you. I hope it made sense but I'm sure Dr. Kozin could explain it better than I ever could. (We're moving in a couple of days and getting ready for trial so there's minimal sleep these days)
Cindy