Brachial Plexus Birth Palsy, Humeral Osteotomy: Mariah's Story

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Mariah, 13, is a talented basketball player. She’s the lead scorer on two teams and will even play on her high school’s varsity basketball team as a freshman. This is all despite a birth injury that left her right arm partially paralyzed as a baby and limited its movement for most of her childhood. Surgery at Children’s Hospital of Philadelphia has given Mariah greater range of motion in her arm, setting her on a path to even greater success in the years ahead.

Mariah smiling standing with parasolNisa, Mariah’s mother, remembers noticing that something was wrong as soon as her daughter was born. “I saw that only one arm was moving.” Doctors confirmed that she had a brachial plexus birth palsy, partial paralysis of her right arm caused by an injury to nerves of the brachial plexus, which run from the spine through the shoulder and control movement in the arm and hand. In addition to the paralysis, her right shoulder was turned inward.

With physical and occupational therapy as a baby and through early childhood, Mariah gradually gained some movement in her right shoulder and arm. Her hand and wrist also shifted to gained strength and function. She favored her left arm because of the injury, but began writing with her right hand as a preschooler, suggesting that she might have been right-handed without the nerve injury.

“She found ways to compensate,” says Nisa. “I tried to make her do more than she thought she could. I encouraged her to think she could do anything with that hand. We never allowed it to get in the way.”

Nisa played basketball in college and is now a basketball coach, so it was natural for her to get her daughter on the court. At age 5, Mariah was making baskets on an adult court, shooting with her left hand. By age 7, she had become skilled at dribbling and layups. As she grew, Mariah worked on shooting and dribbling with both hands, but always favored her left.

Finding help at Children’s Hospital

When Mariah was 12, her grandmother found an article about another girl with brachial plexus birth palsy. Surgery improved the range of motion in her arm. The family started doing research and found that Children’s Hospital of Philadelphia (CHOP) had a team of doctors with expertise in Mariah’s condition, and had performed many similar operations.

Nisa called and made an appointment for Mariah to be seen by Apurva S. Shah, MD, MBA, a pediatric Orthopaedic Surgeon at CHOP who specializes in hand and upper extremity surgery and is Co-Director of the Brachial Plexus Injury Program.

Their first appointment was in August 2016. Dr. Shah and occupational therapist Sandy Schmieg, MS, OTR/L examined Mariah, taking measurements to determine the strength and range of motion in her right arm. Dr. Shah explained that Mariah had right glenohumeral dysplasia and a shoulder internal rotation contracture, a relatively common result following brachial plexus birth palsy. This means that her right shoulder joint had become misaligned over time, making it difficult or impossible for Mariah to reach her face and the back of her head. He recommended a surgical procedure called humeral external rotation osteotomy to correct the alignment of her shoulder and extend the range of motion in the arm. During the operation, Mariah’s humerus (arm bone) would be cut and rotated outwards.

Nisa found it amazing to discover a doctor who was so knowledgeable about brachial plexus injuries. Until then, she had been working with doctors and physical therapists with a much more limited understanding her daughter’s condition. Both Nisa and Mariah were impressed with how clearly Dr. Shah explained everything.

Dr. Shah operated on Mariah on Sept. 16. Two days later she felt well enough to go out to a movie with a friend. While she was required to wear a sling for four weeks, she was able to move her arm within days.

Making moves toward recovery

Mariah smiling standing with basketballOne morning about a month later, Mariah woke up with her right arm over her head. She had never been able to extend it that way before, and was initially scared that she had hurt it — she hadn’t. The new flexibility was the result of the operation, and that became a comfortable position for her before long. Mariah soon found it easier to bring her right hand to her face and to reach behind her head.

The day before the three-month mark, Dec. 15, Dr. Shah gave Mariah permission to play in a basketball game. She didn’t use her right arm much at first, but it felt great to be back on the court with her school team.

By the spring, she was the leading scorer on two different basketball teams. Nisa could see the difference in her play. “Before, she would never go between her legs or behind her back. Now she can, and those have become go-to moves. She used to go for rebounds only with her left hand, barely jumping for the ball. In one game, I saw her jump over someone’s head and grab the ball with both hands. She’s always been a very good player. Now she is very very good. The other teams can’t stop her.”

Mariah is likely to get much better as she matures, not just as she grows and refines her skills, but as she continues to gain more flexibility in her right arm. She’s already a star player despite not being able to fully extend her right elbow. She’s working with an occupational therapist at CHOP’s Specialty Care location in Exton to gain that flexibility, with the aid of a splint that holds the arm in an extended position every night while she sleeps.

“One of the results I like the most from the surgery,” says Nisa, “is how much more comfortable she seems with her body. She would never wear a tank top before. She was a little self-conscious. Her right shoulder was not as big as her left shoulder, and her elbow used to wing out. Now her shoulders look the same and her elbow doesn’t stick out. If she’s able to straighten her elbow you won’t be able to tell that there ever was an injury.”

In addition to sports, Mariah loves music, dancing, hanging out with her friends and shopping. She also a very good student. With her many strengths, she has a bright future ahead of her.

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