United Brachial Plexus Network, Inc.

My daughter had botox put into her triceps about 2 years ago. Her biceps now can move wonderfully, but her triceps will not move at all. Anyone with this problem and what have you done to try and help the problem?
Thanks Tisha

The same thing happened to my daughter. We have tried everything without success to get the triceps to move again.

What you are both describing sounds a lot like what many kids experience when their biceps "start working" except that in your cases the biceps being able to start working was triggered by botoxing the triceps. In many kids, once the biceps start functioning, the child essentially "turns off" the triceps in order to allow the weak biceps to get the child's hand to mouth, etc. Thus the early "waiter's tip" posture - a rigidly extended arm from triceps holding very tightly - very often turns into the "Erb's engram" - the stereotypical posture of bent elbow and internal rotation, sometimes almost overnight. It's really bizarre because it literally is one minute, the arm is always extended and then suddenly, it is always bent...! So I'm guessing that what you are both seeing isn't directly a result of the botox so much as it is a fairly typical reaction of BPI children to regaining biceps movement.

If that is the case, what worked for us during this period with Joshua was to set up reaching exercises where his arm was fully supported up in the air. We used the couch, as it was the perfect size for him at that age, but you might try at the table or kitchen counter; you want something that is right at shoulder height so as to fully support the arm to allow the biceps and all the other shoulder muscles to relax. Then put something - such as candy (Joshua loved grapes!) progressively further away that require extension of the elbow and activation of the triceps. The completion of the exercise is that the child wants to bring whatever it is she grasped to her mouth- which works the biceps muscles in the very seldom used "end" range, which is where they tend to be the weakest.

The key is to help the child learn to turn on and off the biceps, in order to enable the triceps to activate again. But you also need the child to strengthen her biceps' ability to contract from a fully extended position. If the biceps are weak, they will be especially weak in a fully extended arm and so the child will be reluctant to ever let her arm fully extend! Thus, a weak biceps begets a weak triceps and back and forth. Getting the triceps to activate is important, but equally important is strengthening the biceps in that end range, so the child will be "willing" to allow the triceps to work at all.

We also found that an internal rotation posture really worked against Joshua's triceps, as it tends to further weaken the biceps and exacerbates the kind of "constant on" of the muscle described above. Once his excessive internal rotation was corrected, his triceps "suddenly" got a lot stronger again.

Kate

My daughter was evaluated by the neurologist who administered the botox as well as other specialists. They have all determined that the loss of her triceps is directly related to the botox, and by this point, it is irreversible. I'm sure what you state is true in most cases, but not ours. The triceps is actually what they consider a permanent paralysis. I hope and pray that the reason that the other people who experience this, is what Kate says. It is hard to completely lose a muscle that once worked well. Every specialist who we saw told us that there are many risks to botox and some of the risks are severe and permanent. They also said that the risks aren't as low as most think, or as most doctors explain. This is our experience.

Taneesha,
I am sorry to hear this. I know that I am reading it a year later, but it does frighten me. Has your child regained triceps function?
Nicole

Unfortunately she still doesn't have triceps. Our regular specialist (Dr. Nath) wasn't the one who administered it, but it was given by one of the other well known groups (I won't say the name in order to not offend anyone) so I'm confident that it was given correctly. We have seen many specialists and they've all said it was given correctly and the dosing and everything was correct. I got the reports so they were able to see the information accurately. It is just one of the side effects that can happen when botox is given.

Hi Taneesha,
I tried to email you...but was unable to "deliver" it to that address. Nicole

Woops, sorry. I forgot to update my profile when I changed e-mail addresses. I updated it now so it should be current and correct.