Brachial Plexus Injury

Brachial plexus injury (BPI) can be a special need for children adopted from China.  Since Caleb has this special need, I thought I would share what living with it is like. For more specific information about the diagnosis and treatment options available, check out the United Brachial Plexus Network.

Before we brought Caleb home, we had no idea to what extent his arm was injured. As most people in the adoption community do, we hoped for the best but expected the worse. What was the worse case scenario? Complete avulsion of the nerves. This turned out not to be the case, and we were delighted.

In China we could see how his shoulder was internally rotated and that he had very limited ability to abduct his shoulder or rotate it.  He learned to compensate, using his trunk to raise his arm instead of his shoulder, and his finger extension was poor.  Voluntary use of his arm was limited.  He would "self range", meaning use his right hand to place his left hand where he wanted it to be.  Here are short video showing his arm function, taken shortly after returning home (mostly) from China with Caleb.  If you look closely, you can see the times in which I encouraged him to use his left arm.

He was 3 years old and had no therapeutic experience at this point. Shortly after beginning physical therapy (PT), we learned that Caleb was, in fact, a candidate for surgical treatment that would vastly improve his arm function. We were delighted, though finding a surgeon covered by our insurance proved a bit more difficult. We had Caleb evaluated by Dr. Raul Nath in Houston. However, we had an uneasy feeling about moving forward. We eventually learned about Dr. Kumar Kadiyala in Miami, FL, who had trained under Dr. Peter Waters in Boston, MA. We had Caleb evaluated and felt very comfortable about proceeding with surgery. Caleb was home almost one year when he had his surgery. Although extensive PT and OT had improved his function, his greatest improvement followed his muscle/tendon transfer surgery.  We are extremely grateful to Dr. Kadiyala for all that he has done for Caleb.

Below is a video I shot of Caleb playing in the yard about 4 months post op.

Caleb continues to receive PT and OT weekly, though we have cut back significantly on the number of weekly sessions. It's been 3 years since his surgery, and at this point, we've seen his progress plateau. We know that maintaining this progress will require a significant commitment to ongoing therapy, not just now but as he ages as well.

Caleb now has an elbow splint that he wears daily to keep his bicep stretched and reduce muscle contracture (and maintain shoulder abduction.) We can clearly see that his C-7 nerve was also affected because of his limited hand strength and finger flexion/extension. There are some things that he simply does as if he was one-handed, like typing and managing buttons and zippers. He also throws and catches with his non-affected arm when playing baseball. Because he can't completely straighten his left arm, he will have to golf left-handed instead of right-handed. None of these issues are a big deal. It's just the way life is. He'll do some things a little different.

Since it has been 3.5 years since Caleb had his muscle/tendon transfer, I thought I would videotape him doing some of the same tasks we attempted over 4 years ago.  You can see just how far he has come!

If you have any further questions about brachial plexus injuries, feel free to email me or leave a comment.  If I can't answer your question, I can hopefully steer you in the right direction.  Thanks for your interest in BPI!