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Spring 2009

Case Study: Child Finds the Power in Raising Her Arm

Brachial plexus birth palsies are among the most challenging orthopaedic issues in children. These traumas often leave a child with a spectrum of weaknesses and loss of function, the most common being the inability to raise the arm overhead, due to a lack of muscle and damaged nerves. Such was the case with MP, who arrived at Shriners Hospital for Children Northern California when she was 5 years old.

Since 2001, Lisa Lattanza, M.D., chief of the Hand and Upper Extremity Service at UCSF Medical Center, has been attending once a week at the Shriners Hospital Northern California in Sacramento. Working in partnership with Shriners Chief of Orthopaedic Surgery Michelle James, M.D. — and with a team of pediatricians, rehabilitation specialists, and occupational and physical therapists — Lattanza spends time in both the clinic and the operating room.

When MP arrived, Lattanza's first step was to assess what was possible. "Success in these cases depends on experience in performing the procedure and patient selection," she says. "Sometimes, in more severe cases, the child may not have enough muscle to justify a procedure. This, of course, can be very hard for parents to understand."

In MP's case, however, while the child could not raise her arm enough to be fully functional, Lattanza was convinced that an external rotation tendon transfer held a good chance for success. She led a surgical team that transferred an unaffected muscle from MP's back and moved it to her shoulder, so it could do the job of the damaged muscles and tendons.

"This type of surgery at the shoulder works better in children than adults, and involves meticulous dissection around many delicate nerves and blood vessels," says Lattanza. "Ultimately, function is predicated on selecting the appropriate new site for insertion and on intensive occupational and physical therapy with therapists who are experts in treating children."

As the photos above demonstrate, MP has made dramatic gains in function in the two years since her surgery.

Lisa Lattanza, M.D. can be contacted at (415) 353–7584.

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