The most important development in the past several years has been the understanding that nerve grafting is less important than dealing with the muscle and bony problems that arise as a result of the original nerve injury.

In other words,nurturing the nerves as they recover is our philosophy, with nerve grafting and nerve transfers to be performed in the most severe cases.

In many cases, the use of Botox allows biceps and shoulder function to recover without the need for surgery. The concept that surgery will improve function in OBPI has been supported in many other studies worldwide. It has been established, for instance, that contractures develop and cause bony deformities so that shoulder joint development progressively gets worse with time.

How does nerve injury lead to muscle and bony problems?

Most obstetric brachial injuries involve the upper part of the plexus, not the lower. This causes unbalanced growth of the arm during a critical time in the child’s development.

Infant growth curves show that this is the time of fastest growth at any time in the child’s life. Even small imbalances can therefore result in major growth disturbances. Contractures are addressed with the Mod Quad surgery (performed several thousand of surgeries by Dr. Nath) and Triangle Tilt surgery (performed several thousand of surgeries by Dr. Nath)