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Patient Guide
Brachial Plexus Injury
Nerve (Primary) Surgery
Muscle Surgery
Mod Quad Surgery
Muscle Surgery Bicep Tendon Lengthening Surgery (BTL)
Triangle Tilt (bone) Surgery
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Resources

  • Before and After TT
  • Bony Improvement - Before and After - Mod-Quad and TT

Muscle Surgery Illustrations & Animations

Mod Quad Surgery

The need for secondary surgery does not mean that the primary surgery failed. It describes another type of surgery done later in time used to correct muscle imbalances that occur as a normal result of having a brachial plexus injury.

The situation of muscle imbalance is very common especially among those who have upper trunk (Erb’s Palsy) injuries. In our experience the majority of children whose injury does not completely resolve by 3 to 4 months of age will end up with a specific series of arm restrictions caused by a muscle imbalance between injured and uninjured muscles.


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At the same time, the internal rotators (muscles that turn the arm and palm inward) and adductors (muscles that pull the arm to the side) of the arm are not involved in the injury because they are supplied by the lower roots of the plexus. Therefore, these strong muscles overpower the weak muscles and over time the child cannot lift the arm over the head or turn the palm out, because of the muscle imbalance.




*You must download Windows Media Player 9.0 to view before and after videos. Click the link provided and you will be prompted to install the player.

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Mod-Quad Surgery Example

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before after

 

Patient example of Mod Quad surgery for brachial plexus of the patient's left arm. Dr. Nath has done over 2800 Mod Quad surgeries on children and adults.

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Biceps Tendon Lengthening Surgery

With an elbow flexion contracture, there is limited range of arm movement. This range can be greatly increased with a biceps tendon lengthening procedure.


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Free Gracilis Transfer

before after

 

Patient example of Free Gracilis surgery for brachial plexus injury of the left side.

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Wrist: Releases, Transfers, Decompressions

Wrist, finger and thumb movements are often affected, leading to problems with hand grasp and finger pinch. A series of tendon/ muscle transfers can help to achieve excellent function with these injuries as well. The basic principle is that some strong muscles and tendons can be re-routed to strengthen weaker functions by sewing the transferred tendons into the paralyzed ones.

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