Search by category General Triangle Tilt Research/ Stem Cells Mod Quad
Search by writer Dr. Nath Andrew
Search by Date 2005-10-21 2005-10-22 2005-10-23 2005-03-21 2005-10-24 2005-05-11 2005-09-15 2005-10-26 2005-09-02 2005-10-27 2005-10-28 2005-09-20 2005-10-31 2005-11-07 2005-11-09 2005-11-10 2005-11-02 2005-11-03 2005-11-21 2005-11-05 2005-12-06 2005-12-07 2006-02-26 2006-03-30 2006-03-22 2006-05-02 2006-03-26 2006-04-25 2006-05-09 2006-05-13 2006-07-10 2006-06-26 2007-01-15 2007-01-22 2007-01-30
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2006-07-10 International Doctors- Morocco
Author: Dr. Nath
Several weeks ago, I received an email from Dr. Abdelouahed Amrani, a pediatric orthopedic surgeon from The Children's Hospital of Rabat, Morocco.
Dr. Amrani wished to learn the techniques performed at Texas Nerve and Paralysis but could not afford to travel here.
We then decided to sponsor a traveling fellowship for interested brachial plexus specialists who were unable to travel to Houston for financial reasons, but still wished to learn our techniques.
Dr. Amrani was the first recipient of the fellowship and spent a busy week here learning our evaluation and management techniques.
2006-06-26 International Doctors- India
Author: Dr. Nath
Several months ago, as part of the inaugural meeting of the International Society for Brachial Plexus and Peripheral Nerve here in Houston, I had the opportunity to discuss my specific techniques for the Mod Quad surgery with a surgeon from India, Dr. Raja Sabapathy from Coimbatore in South India. He is a skilled microsurgeon and has a growing practice in brachial plexus surgery.
Dr. Sabapathy and his partner have tried the surgery and the email below reflects their experience with the Mod Quad and other procedures we use in our practice:
"Dr. Raja Sabapathy has gone to Glasgow to attend the FESSH meeting. He asked me to send you the details of OBPP cases which we have done recently.
We have done 4 cases of Mod.Quad.release with extremely gratifying results.
We also had the opportunity to inject Botox into the triceps in 2 cases.
One of the child was referred by you who had
undergone Mod.Quad release at your centre in December 2004. We injected 50
IU of Botox into the triceps muscle.
We have been receiving lots of enquiry from the patients who have contacted
you. We will keep you updated as and when we operate upon them.
Dr. Hari Venkataramani
http://www.drnathbrachialplexus.com/weblog/weblog_videos/20060626095742finu.wmv
Excellent use of both arms after Mod Quad surgery
2006-05-02 Reasons for Triangle Tilt Surgery
Author: Dr. Nath
The internal rotation and shoulder subluxation deformity of the arm is common in children with obstetric brachial plexus injuries. This is the specific deformity that the Triangle Tilt surgery was designed for. The particular deformity has been known for over 100 years : Whitman in 1905 wrote that the large majority of internal rotation and subluxation deformities of the shoulder in children with obstetric brachial plexus injuries was caused by fibrosis and contractures during the period of paralysis: it was a consequence of the neurological injury. . (Whitman R, Treatment of congenital and acquired luxation at the shoulder in childhood. J Am Med Assoc 42: 110-15, 1905)
Professor Rolfe Birch of the Royal National Orthopedic Hospital in Stanmore, U.K. described the problem in 2001:
"Medial rotation contracture and posterior dislocation of the shoulder is the most common and most significant secondary deformity in obstetrical brachial plexus palsy (OBPP). Surgery to correct the deformity proved necessary in more than one third of the 1200 children seen in our unit from 1982.
Diagnosis is often delayed, and the untreated deformity has severe consequences for function within the upper limb as a whole. By late adolescence or early adult life, movements of the shoulder girdle are greatly restricted . The upper limb lies in fixed medial rotation; there is pain from the disorganized gleno- humeral joint; and there is flexion pronation posture of the elbow , often complicated by subluxation of the head of the radius . Most children with OBPP progress to good or at least useful neurological recovery, and it is the duty of orthopedic surgeons to encourage this potential function by earlier detection and more appropriate treatment of this deformity"
Birch, R., Medial rotation contracture and posterior dislocation of the shoulder, Chapter in Brachial Plexus Injuries, Gilbert, A. (ed.), Martin Dunitz, London 2001.
Typical Untreated Medial Rotation Contracture of the Right Arm: Shortening, Flared Elbow, Winged Scapula, Pronated Forearm and Hand
2006-04-25 Triangle Tilt for Older Patients
Author: Dr. Nath
Below are 3 young ladies with internal rotation contractures from obstetric brachial plexus injuries. All three were about 12 years old, currently about the oldest that triangle tilt surgery is done; and all three were scheduled on the same day for surgery. We try to have similar ages done on the same day whenever possible so that the kids and families can socialize and share experiences.
That certainly worked out well in the case of these teenagers and they made friends for a lifetime, having shared a very important experience in their lives.
Three friends the day after surgery
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