surgery for elbow contractures

[baby4us]

Kate,

Thanks for your post, please continue to update us on your findings!!! I'm digesting it now, but may email/post some questions later.

[njacoby499]

I was wondering if anyone is having the same situation as my son. He still has no use of his arm and no muscle after 3 surgeries. He is hyperextending his elbow 22 degrees. We had it xrayed the other day and it isn't dislocated. They are going to splint his arm. Would the mod quad help him?

[admin]

Allison,
You know we used botox twice on Juliana, and we were concerned as well... We finally got stuff back and you want us to paralyze it????????? However, the paralysis is only temporary, and gives you time to work on other things. There are probably exercises you can't do because the contracture is there, if you temporarily weaken the contracted muscle then you can work on strengthening opposing muscles.

Like I said, in retrospect, I would not rush into biceps lengthening surgery. The surgery came highly recommended to us, and at that time we were still so unsure of botox that we wouldn't use it. We all make decisions based on the information we have at hand at that time, but I would try botox first---it is temporary.

claudia

[njacoby499]

They were going to try Botox on my son, but he doesn't even have enough tricep to do it. I hope that when we see Dr. Nath in October he will have some different options for us. I am still curious if anyone has this same situation or something close.

Natalie

[katep]

Natalie,

Keep in mind that secondary surgery (such as the Mod Quad) is basically there to balance existing muscles, through muscle releases (partially or fully detaching overly strong muscles) and tendon transfers (changing the action of certain muscles). It does not provide function, per se, but redistributes it. Transfers and releases won't create function from nothing. In that case, the approach is generally free muscle transfers (implanting a new muscle such as the gracillis along with a transfered nerve supply) or transfers of existing nerves to attempt to establish innervation, in order to try to get something working first.

Here is an article that explains it better (for some reason the formatting seems all whacked out, but it is still useful):

http://www.indmedica.com/cyberlec1.cfm?clid=25&catid=10

Kate

[baby4us]

Kate...

To make sure I understand, my child has strong biceps and weak triceps...so she may be more of a candidate for this, depending on the cause of the contracture?

Also, perhaps in your survey you should find out which is stronger on the child, the bicep or tricep? Just a thought.

[katep]

Hi baby4us,

Please don't take this as a challenge or anything, but can you explain how do you know your child has stronger biceps than triceps? For instance, my child is developing a biceps contracture, but if I try to bend his elbow when it is straight and he doesn't want to bend it, he can resist me very strongly. But if I try to straighten his elbow when it is bent and he wants it bent, I can easily overpower him.

Does your child resist you when you try to bend or straighten their arm? What are the relative strengths of their resistance in these two different situations?

Kate

[PeggyUBPN]

My daughter had biceps and very weak triceps; we did the dynasplinting first for a few years. It could get the contracture to 0 degrees, but it was an on-agian, off-again thing. She went in for a biceps lengthening in December, which actually turned out to be a release in the biceps and haveing the acromioplasty done.

She's doing beautifully and the triceps are more active! Gaining triceps wasn't a goal of the surgery, but it was sure a nice perk!

Peggy

[admin]

Kate, in our case we had virtually no triceps and have little biceps. We have 3 opinions that said that even if biceps are the slightest bit stronger than the triceps then a contracture forms. We have no internal rotation problems. I don't think you can generalize on what this problem is because I think there's a huge matrix on the biomechanics of why this happens.

All I do know (for us) is that the biceps tendon lengthening gave my kid a straight arm, more natural looking arm without any loss of strength (after time in therapy to strengthen). And a year and a half later there is no return of a contracture. We have been e'stimming her triceps so maybe we've done our job in correcting the imbalance. I would think that if we didn't follow up and do the strengthening that by now we would be back to step one, but we have committed ourselves to do the necessary followup work and I believe its paid off.

[baby4us]

Let's see...

She and I can easily bend her arm in, and I can easily straighten it out, as can she. She tends to straighten it out with thumb up and it seems to take a lot of thought to then put the thumb down. (I'm noticing this now because we are working on getting her to put her hands behind her back and we do it by putting arms straight out, thumb down, and then bend at the elbow).

I have always been able to work through the resistance pretty easily and quickly, so I don't know about where I can overpower her...I guess she's pretty compliant when it comes to her stretches!! So I guess I'll have to think about your question more and try to pay more notice the different areas of resistance.

All her therapists (3 different ones), and her surgeon say she has weak triceps. Her bicep bulk is pretty large and you can see muscle tone. Her arm does not bend out to the side like a lot of kids I've seen, she holds it bent a bit closer to her body, more like a marching soldier if that visual makes sense.

Does this help explain things? I have her latest OT report and I can give you numbers for things if it might help clarify things.