• Team Approach Gives Ben Use of Arm

    Ben Adkins was born with a brachial plexus injury, following a difficult labor and delivery. He had no functional use of his right arm. To improve his range of motion and ability to bend his elbow, Ben has undergone multiple surgeries.  

    A Difficult Beginning

    After a difficult labor and birth, Benjamin Adkins was whisked away to the Neonatal Intensive Care Unit at Defiance Hospital in northwestern Ohio. He required oxygen after aspirating fluid into his lungs. Later that night when his mother, Anne, visited him in the nursery, she began to notice another unrelated complication -- paralysis of his right arm. Anne was told that her son's arm would most likely recover on its own. When a nurse from an early intervention program stopped by the family's house three weeks later and examined Benjamin's still non-functional arm, she recognized the signs of a brachial plexus injury.

    Ben and Matthew on their first day of school.

    Ben, with an arm cast following surgery, and his brother Matthew on their first day of school.

    The brachial plexus is a network of nerves that conducts signals from the central nervous system to the shoulder, arm and hand. When the brachial plexus is injured, which can range from mild overstretching (neurapraxia) to complete nerve separation from the spinal cord (avulsion), a child might experience limited range of motion, weakness, shortening of the limb, lack of functional use and/or loss of sensation in the affected arm.

    Having never heard of a brachial plexus injury, Anne felt overwhelmed. Ben's pediatrician referred the family to an out-of-state brachial plexus center that wasn't within driving distance from the family's home.

    Ben underwent nerve grafting surgery, which consists of attaching healthy nerves to defective ones to stimulate re-growth. This gave him more movement in his fingers. Ben had a second surgery called the "Mod Quad" procedure. This involved releasing strong muscles that were causing Ben's arm to turn inward and transferring muscles to replace the weaker ones that controlled his ability to turn his arm outward (external rotation) and raise his arm out to the side (abduction).

    Family Seeks Family-Centered Care

    Although Ben's parents were happy with the results of his first two surgeries, they were still concerned with Ben's lack of bicep function. After sending in a videotape for his "yearly check-up," Ben's brachial plexus surgeon told Anne that Ben needed an additional shoulder surgery. She disagreed and felt that another shoulder surgery was not the best treatment option for her son. Since Ben's shoulder had already been addressed, she wanted to focus on improving Ben's bicep function to allow him to bend his elbow and place his hand where he wanted it to go, which would give him more independence.

    Wanting to avoid the next in what Anne calls "an assembly-line of surgeries," the family decided it was time to search for another caregiver who was more compatible with their philosophy and approach to their son's needs. Anne found the Brachial Plexus Center at Cincinnati Children's after searching on the United Brachial Plexus Network web site.

    Anne describes their first visit to the Cincinnati Children's Brachial Plexus Center as memorable. The center's multidisciplinary team of brachial plexus specialists asked for the family's input, such as what Anne would like to see her son do and what her concerns were about his arm.  They were receptive to her feelings regarding Ben's lack of bicep function and were willing to work with the family to meet their needs and goals. "I knew we were in the right place," Anne said. "The people at Cincinnati Children's didn't want another number for their [surgical] records. They honestly wanted to help my child."

    Ben Exceeds Expectations After Surgery

    In order to improve his range of motion and ability to bend his elbow, Kevin Yakuboff, MD, Plastic and Reconstructive Surgeon, performed a gracilis transfer on Benjamin's arm. This involved transfer of the gracilis muscle in Ben's leg to the place in his arm where it would act as a bicep muscle. Anne remembers that Ben surprised them all by how quickly he was able to bend his arm on his own for the first time, exceeding even the doctor's expectations.

    Ben had another surgery to help further improve his range of motion and external rotation. Performed by Charles T. Mehlman, DO, pediatric orthopaedic surgeon and co-director of the Brachial Plexus Center, Ben underwent an arthroscopic release of the subscapularis muscle and anterior shoulder capsule.

    Ben Adkins in brace after brachial plexus surgery.

    Ben in a "Statue of Liberty" or "High Five" brace following surgery.

    During this surgery, Dr. Mehlman used a laser to release Ben's tightened subscapularis muscle to allow his arm to move more freely. Following the procedure, Ben was in a "Statue of Liberty" or "High Five" brace, named to describe the placement of the arm in an upward position, for six weeks. He also had to do physical and occupational therapy several times a week to help build his strength and improve his flexibility.

    Ben's quality of life greatly improved now that he has bicep function and increased range of motion. Before the surgeries, he had no functional use of his arm. "I remember two weeks after the gracilis surgery, you could actually see his bicep flexing! It was amazing how well the surgery 'took' and how quickly we were able to see results," Anne said. "He uses his arm so much more now. He doesn't have to flop it into place as much as he used to. He seems to actually use muscles to move his arm how he wants. The release really opened up his range of motion, which is really helping with the elbow. He's becoming more and more functional every time we look."

    Family Gains a Sense of Security and Promise for a Bright Future

    Ben, his family, his occupational therapist and the Brachial Plexus Center team work together to improve Ben's arm function. Ben visits the Brachial Plexus Center yearly to check on his progress. His mom attributes his success partially to his outgoing personality and attitude. "He doesn't let anything stop him," Anne said. "He takes it all in stride, with his 'this is how it is, so let's deal with it and move on' attitude." In addition to being able to grip with his hand, Anne describes Ben's elbow flexion and active movement as amazing.

    Anne is grateful for the family-centered care she has received from Cincinnati Children's. "What I really appreciate is that they [the faculty and staff at Cincinnati Children's] firmly believe the parent's involvement in a child's treatment is absolutely necessary," Anne said. She believes that the support from the Brachial Plexus team has made the injury less stressful for her family and has given them a sense of security and promise. "Working with the people at Children's has allowed me to put his injury in perspective," she said. "It's no longer, 'This is Ben, he has a brachial plexus injury.' It is now, 'This is Ben, he's six and he's in kindergarten.'"

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