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Shortly after birth, Amari's family noticed that she couldn't move her left arm. When movement didn't improve after a month, Amari's mom sought help from the Brachial Plexus Center at Cincinnati Children's Hospital Medical Center. Diagnosed with Erb's Palsy, Amari's parents were told that she would need surgery to repair the damaged nerves. Today, at age 20 months, Amari enjoys playing catch -- using both hands!
After being stuck in the birth canal during a difficult labor, Amari Bumpus was not breathing when she was finally born. Fortunately, she recuperated quickly and appeared to be healthy, except for noticeable paralysis of her left arm. Her injury was described as a "stinger" by physicians, which is a term used to describe a sports-related nerve injury that spontaneously heals itself. Her parents, Nichole and Andre, were told that the nerves were asleep and would eventually "wake up."
When Nichole noticed no improvement after the first month of Amari's life, she knew her daughter's condition was more serious than originally thought. Even though she was reassured by the pediatrician that the arm would eventually recover, Nichole was not satisfied and instinctively felt that intervention was needed for her child.
A friend suggested that Amari could have a brachial plexus injury, a common birth injury that involves damage to a network of nerves in the neck that controls the arm and hand. Amari's mom mentioned this to the pediatrician, who then referred her to an occupational therapist. In addition to prescribing therapy every two weeks, the occupational therapist started Amari on a home program with daily exercises. The therapist also recommended the family visit the Cincinnati Children's Brachial Plexus Center, where a team of multidisciplinary experts specialized in treating children with brachial plexus injuries.
At three months old, Amari was examined by the Brachial Plexus Team and diagnosed with Erb's Palsy, which is damage to the middle and upper nerve roots of the brachial plexus, and the most common form of brachial plexus injury.
Typical of this type of injury, Amari's arm was paralyzed and internally rotated (turning inward toward her body). Her hand had some function but was stuck in a position known as "waiter's tip" because the palm is turned upward as if receiving a tip.
Nichole's swift efforts to find answers paid off. The family learned that in order to repair the damaged nerves, surgery must occur within the first six months following the injury. If they had waited too much longer to seek treatment, Amari's muscles could have atrophied (worsened) to the point where reinnervation, or re-stimulation of the nerves, would be impossible. At that point there would be other surgical and non-surgical options, but the nerves, a crucial element to arm and hand function, could not be repaired.
After a few clinic visits to evaluate her arm through physical examinations and an EMG test, Amari underwent primary nerve repair surgery when she was six months old to improve her range of motion, elbow flexion and hand function. Kevin Yakuboff, MD, Plastic and Reconstructive Surgeon, transferred part of a healthy nerve to the damaged one to stimulate nerve re-growth. He also performed an Oberlin transfer, which is a transfer of the ulnar nerve to the musculocutaneous nerve to assist with bicep function and elbow flexion (moving her arm and bending her elbow).
"Everybody was really supportive. They let us walk her all the way into the operating room and were very attentive while we waited during the surgery," Nichole said. Amari's parents liked that they were able to call in to the surgery room to inquire about how everything was going and that the surgery room would call out to give them updates. "This meant a lot to us," Nichole said. "It was a four-hour surgery and felt like a very long time. Being able to communicate with us helped us get through it."
Nichole and Andre appreciated that Dr. Yakuboff met with them immediately after the surgery to discuss Amari's condition. Using a dry erase board, he illustrated and explained what he had done to Amari's nerves so they could visualize and understand the procedure. After this, Nichole and Andre joined Amari and were able to be with her when she woke up from the anesthesia, which was really important to the family.
Amari wore an ace bandage wrapped around her arm and waist, earning her the nickname "Little Mummy" by her siblings. Two weeks after surgery, Dr. Yakuboff removed her stitches and put Amari's arm in a sling for another week. After one month, Amari resumed physical and occupational therapy two days each week and continued doing exercises each day at home.
Since her surgery, Amari's arm has improved significantly. Although they originally thought she wouldn't be able to crawl, Amari surprised her family at nine months with her crawling ability. She can move her arm in an up-and-down motion and has increased her ability to use her hand. "The change from where she was with only hand function to what she can do today is phenomenal," Nichole said. Unable to move her arm before the surgery, she can now play with her left arm, touch her hand to her mouth and even touch her hair. Today Amari is an amusing, active 20-month-old who loves to play catch with balls, using both hands.
Even though Amari's improvement is impressive, her arm is not 100 percent healed. It still sticks out in what is termed a "trumpet" position when she bends her elbow, and she still has some limited range of motion. To treat these other issues surrounding her injury, in the spring of 2006, Amari received Botox injections in her shoulder to relax her strong arm muscles, allowing the weaker ones to build strength. This procedure has helped her range of motion and has improved muscle balance, allowing for better alignment and growth. She will be receiving more injections in the future to continue the strengthening of her weaker muscles.
Amari continues to be seen at the Brachial Plexus Center every few months and has therapy once a week, in addition to her home exercise program. When she is older, other surgeries for her shoulder will be considered if the team and family think this would improve her arm function even more.
Dr. Yakuboff is pleased with her progress. "Amari's results are a good example of a team approach to treating this complex injury," he said. "We are constantly looking for ways to improve results."
If you have an experience with Cincinnati Children's, we invite you to share your story.
Diagnosed with Erb's Palsy, Amari's parents were told that she would need surgery to repair the damaged nerves. Today, at age 20 months, Amari enjoys playing catch -- using both hands!
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