United Brachial Plexus Network, Inc.

I have a question regarding the mod quad,is it for the active motion or passive motion?
my baby 14 month had primary at 6 months old has full range of passive motion , he can reach 180 degree over head but passivly (90 degree only activly) also the external rotation full range passivly
can the mod quad improve the active also??!!

It's important to note that the term "Mod Quad" was coined by one center as their name for tendon transfers in the BPI shoulder. Other terms used by other centers are tendon transfers or L'Episcopol/Sever/Hoffer procedures. There is considerably variety in exactly which tendons are transferred, how and where (such as lats or teres major only, or conjoined tendon transfered by rerouting over or under various structures, attached to the humeral head directly, another tendonous insertion point, etc). CONSIDERABLE variety! Even the two doctors who use the term "Mod Quad" perform parts of the surgery very differently.

The basis of all these procedures is to supplement external rotation in order to enable the existing abductor muscles (deltoids and supraspinatus) to work effectively. The lat and teres major are transfered to the rotator cuff or the humeral head which converts their action from one causing adduction and internal rotation to external rotation. When the arm is internally rotated, the abductor muscles (middle deltoid and supraspinatus) are mechanically defeated. Assisting active external rotation enables the existing abductor muscles to function more effectively. This is one reason for varying outcomes with secondary surgery.

So, depending on the recovery of the abductor muscles (deltoids and supraspinatus) tendon transfers may result in a little or a lot of improvement in active abduction. Usually active external rotation is improved, even if abduction doesn't significantly increase.

Also, depending on the surgical approach, varying other muscles can/are released at the same time. There has been long-standing concern over too much release of internal rotation muscles resulting in internal rotation deficits that are functionally disabling. This leads some doctors to be more conservative and take a "less is more" approach to secondary surgery.

Kate

thank you too much katep