United Brachial Plexus Network, Inc.

My son is nine months old and had an LOBPI. He had only weak movement in his fingers at birth, but can now do everything with his left arm except for fully supinate. He has however developed a noticable winging scapula. His PT has told us to focus on weight-bearing, which we have for weeks, but has not seemed to help. Has anyone had a similar situation or know of any helpful home treatments for this condition (i.e. taping?). Thanks.

WE were told recently that weight bearing that is more than the shoulder can hold in proper alignment (in other words if the scapula can't hold in place ) is actually detrimental - we tried weight bearing for years - 12 years - and the only victory we got over the winging is when we started using TES -in conjunction with bracing, stretching the opposing tight muscles , some taping and the right exercises that wouldn't aggravae the problem- but the missing link for us was the TES and brace -now the muscle is grown enough that it can hold the scapula - weight bearing and not addresing the winging with something effective eventually led to a posterior dislocation/ subluxation. If you want more information on the protocols that finally seemed to working for us -go to the tascnetwork.net -and check out Dr.Pape's conferences - The winging scapula case featured there on the lower right is my son - you can see the difference following her protocols have made for us. Weight bearing is important for muscle and bone growth but just need caution if the shoulder is not strong enough yet so that it doesn't get worse. We do weight bearing -but only in positions and angles and weights that the shoulder is able to hold properly .

Our son had the same situation you described, with no supination and scapular winging. His shoulder eventually dislocated - has your son had a CT scan to look at his shoulder? Danny then had the caps/acromioplasty surgeries, which fixed the dislocation, improved supination and helped with the winging.

Weight-bearing, as I understand it, helps with strengthening certain muscles but won't necessarily fix scapular winging. I also know winging isn't always bad; it can be more of a cosmetic problem than an actual medical problem. At least that's how it was explained to us.

I am wondering: Have you taken your son to see a BPI specialist? It may be that surgery is needed to correct some of the problems. I would be interested to see what a BPI surgeon would say, not just a PT.

Good luck to you,
Janet

We have done many things like taping, but our doctor and therapist both agree...we should not do anything real drastic for the winging. Because of the winging, our daughter has the movement she has. The winging allows her to move freely, to comb her hair, to reach in her back pocket, etc. In my daughters' case, I would rather her have the winging and be able to do these things, than corredt the winging, and take a chance of taking away some of her movement. So, with whatever you decide, please make your therapist and doctor take in careful consideration the good and bad that can come from any type of process they decided on for the winging.

we were told the same thing -that not to feel so bad about the winging because that was allowing the range above the head - but as it turned out for us as the winging decreased his range and strength improved -he just started functioning in a more normal pattern where the shoulder and scap could move more independantly as the scaps are now being tethered in their proper place with his new and improved muscles - so we were very gald we didn't lose but gained both strength and range - this was not surgical work on the shoulder but use of TES and bracing and physio and tape. It works for us BIG TIME.

The development and function of the shoulder is one of the key biomechanical issues in recovery from BPI. The problems of scapular winging and decreased supination often go hand in hand. Much of the supination problem is not a nerve issue. It is actually caused by the position of the shoulder. You can demonstrate this with your own body. Put your arm out straight in front at 90 degrees or shoulder level. Now internally rotate your shoulder – and your whole arm and hand will pronate. The palm of your hand will face down to the floor. Now hold your shoulder in that internally rotated position and try to supinate your hand so that it is palm up. Your “normal” hand will only go half way. Now bend your elbow and hold the elbow next to your body. In this position, your forearm and hand can supinate because the shoulder position does not interfere. But the children need to have the shoulder working and be able to supinate in a variety of shoulder positions.
There are a lot of different ways to approach this type of shoulder problem. Some of the problems are caused by muscle imbalance and
some have progressed to bony distortions. This means that some need surgery, some do not, and some are only ABLE TO HAVE SURGERY if they get ready for it. Your surgeon is the best person to assess what is possible in the individual case.
Unfortunately, some shoulder problems are actually caused by weight bearing exercises done without scapular stability. If the child weight bears with a marked scapular wing, then the muscles and tendons that are supposed to hold the scapula into the body are stretched and damaged. And too much bilateral weight bearing, as with wheelbarrow walking, can actually put too much stress even on the “normal” side. Humans were not meant to walk on their shoulders…especially when they are growing. One of the experts coming to the TASC Network BPI workshops is Karen Orlando, a sports PT who has been on the last 6 Canadian Olympic teams and a few Para- Olympic ones as well. When I first introduced her to some older children with BPI, she said their shoulders…both of them…were just like young female gymnasts that also over work their growing shoulders. We are working together to develop some focused shoulder strengthening protocols that use ALL of what is now available to get the bones, joints and muscles working well together. But it is fair to say now that you have to keep the scapula stable while weight bearing. Kinesio-Taping and braces such as the ARK brace are two valuable additions to our overall programs. Ask your therapist to show you how you can do weight bearing with scapular support from your hands as well.

What a great desription to enable us parents to understand what is happening with our children's shoulders. I tried to do the exercise as you described it and it is difficult to supinate while internally rotated. Thanks so much for this great description!

Tanya in NY

We have been using knisio tape for 2 months now and noticed improvement which corrolates with its use. There has been some muscle growth in muscles surrounding the scapula.

I'm not sure how it works exactly. Maybe the tape helps with better placement and support of the scapula resulting in better positioning when weight-bearing; which in turn may result in strenthening the right muscles. Just this week Evan (ROBPI) started crawling with his palm open and moves his arm forward. He's now 22 months and for the longest time he was using his right arm more as a peg with a fisted hand when crawling. We've working on this for so long that to me it feels a huge accomplishment!

We use a wide band of tape under his arm across the Serratus to keep the scapula back. A wide tape is places on the scapula which splits at the end of the scapula to help keep it down and back toward the midline. Also, we put a narrow tape on the Upper Trapezius to help quiet the muscle. Evan tends to compensate and hike up his shoulder along with the winging.

Hope this helps.

Sema