United Brachial Plexus Network, Inc.

Our son has had three surgeries - nerve transfer, mod quad, and capsulodesis. After a few weeks of therapy from the capsulodesis, we discovered that the radical head in the elbow was dislocated.

We inquired to the doctors at TX Childrens about the dislocation. We were told that they do see this in many bracial plexus injuries. If they see this in many cases, why don't they tell parents about the potential for the injury to happen. Their response is that since there are two bones it is more complicated and they do not address it. I was amazed by the response and just wanted them to let parents know about the potential.

Do not take this post wrong. We think that the doctors at TX Childrens are wonderful and the things they have done for our son, a miracle. This post is intended to let parents know about the potential for the injury.

We believe that since our son has had the many procedures that the bicep tendon has not been able to grow as normal. The orthopedic surgeon felt that the short bicep tendon may have caused the radial head to become dislocated after therapy and stretching. During the procedure, the surgeon lengthened the tendon to hopefully prevent this from reoccurring.
You will know if the radial head is dislocated because it will prevent supination. You can also feel the head as a large bump in the elbow joint. If the radial head is out, as with many of the procedures, it is time critical to get it back into place.

Could this have been prevented? Perhaps. If we had know about the potential, we would have been more careful with area, the type of therapy for the elbow, and tried to give the tendon more time to stretch out. We hope that by sharing this information, you will be able to take precautions and will not have to go through another surgery.
Bill

Bill, thanks for the info you are sharing...we are scheduled for my son to have capsulodesis on Monday, Jan. 28. Our OT have been very concerned with his elbow lately, in August Dr. Nath noted a contracture, but was more concerned with the shoulder joint. Now, I had a question about the "bump" in the elbow. Blake's is like a "bump" or knot right at the elbow, I guess at the top of the forearm, where it forms into the elbow. Is this what you mean? I was just curious because our OT thinks it is a bony problem, not just a contracture. Thanks again!!(my son had primary and modquad at TCH, this is his third surgery...they already know about the possibility of bicep lengthening.)

Sorry, Bill, another question...so what did they do to correct the radial head dislocation? They did the bicep lengthening to prevent it from recurring, I understand, but I was interested in how they repaired it initially...thanks for sharing!

My son had a similar problem but the way it was described to me was because of the muscle imbalance the muscles pulled unevenly on the bones and they grew in a deformed way. It would kind of be like at the elbow the one bone grew in an L shape into the other bone. You can't show diagrams on this page but it looked like this:(Ll) instead it should have looked more like this(V). The actual bone growth is what causes it to dislocate.
At age 5 he had the radial head (tip of the bone that was growing wrong)shaved off...unfortunately it has grown back and we've had 3 different doctors tell us to just leave it alone until he's done growing(age 18-19)
He doesn't have the ability to completely unbend his elbow or supinate.
One thing I think that needs to be mentioned is that it isn't so much an injury as it is a growing defect. I'm not sure it an be prevented and I'm sure not all kids do get it. I think the doctors just take it case by case because it is going to be slightly different with each child....I know it did relieve some of my son's pain (at least for 5 years) to have the bone shaved off.
With so many different nerves effected, the potential for lots of different kinds of imbalances to show up is great.
I wish you luck with this I know the pain was unbearable when it was out of joint. He cried all the time and I worried constanly about using too many pain relievers on him. It is so scarry to know you can damadge your childs kidneys or liver!
I wish you the best of luck in finding answers.
T.

I emailed Dr. Nath with the question that asked if there should be any change to the rehab therapy protocol to avoid this issue and he responded:

Francine,

Thr radial head dislocation can occur during any type of therapy, NOT specifically related to capsulodesis or other surgery. Most kids who cannot supinate do not have a radial head dislocation and it does not prevent supination. The dislocation happens because of weakness in the surrounding muscles, and really is not related to surgery but happens at any time. Our orthopedists do not believe it needs management unless there is pain on movement, and in that case they simply would advise removing the protruding piece of bone.

I hope this helps. You can post this if you wish.

RN

I appreciate the post. I hope that I did not confuse the issue. I am sure that there are cases in where the muscles will play a role. We were told the same thing. I only wanted parents to be aware of the potential. If you read the other post regarding Nath's comments, does it not concern anyone that they want to sit back and wait? Especially when they admit they are not specialist in that region of the arm. If you speak to an ortopedic surgeon, time is critical because of the bone growth and other factors. Were are not ones to sit back and hope for the best. We want to do everything possible to give our son maximum use of his arm.

Again, just look out for it and if you feel comfortable with it, have an orthopedic specialist look at the elbow and supination. Our orthopedic surgeon never took a "they are wrong" approach. After we explained the situation, he worked to improve the elbow region while taking into consideration what was being done to the shoulder, both by surgery and therapy.

Thank you again for the post!

We were told from the first day of therapy that dislocations were possible. In fact, shortly after Katie developed that knot in her forearm and we did xrays--our ped had to talk the the radiologist while we took katie and got out of there quick--they would not listen to any of us and was going to contact child protective services. It was a weekend and her ped didn't want us taking a chance on something bad happen so he told us to get out of there quick. He finally got it straightened out.

We were told to support just above the joint that you are working on. The muscles are weak and don't hold the joint in place as well as they should normally.