Gift of grab: Brachial plexus surgery helps tot hug and hold for the first time

Michelle and Waters

“When I first met Dr. Waters, I felt like he was an angel. I knew we were in the right place and in the right hands,” recalls Jonathan Mora. It was November 2009, and the West Haven, Conn. father, his wife and their 6-month-old daughter Michelle had endured a bumpy ride since her birth on May 30, 2009.

During her birth, a brachial plexus injury (also known as Erb’s palsy) robbed Michelle of motion in her right arm. Michelle, like approximately three out of every 1,000 babies born in the U.S., had suffered damage to nerves in her neck and arm. Babies with a brachial plexus injury are treated with physical therapy (PT), and by 6 months, the combination of PT and natural healing usually stimulates recovery.

However, 20 percent of babies don’t recover and nerve surgery is typically recommended. Michelle fell into that group.

After her diagnosis at birth, Michelle’s parents followed the prescribed PT program with a local therapist. The family’s pediatrician assessed her range of motion and muscle strength during her regular well baby visits. Michelle had not started to recover in the first few months after birth; she could not lift her shoulder nor bend her elbow and had weakness in her wrist and hand. Her pediatrician referred the family to Peter Waters, MD, Orthopedic Surgeon-in-Chief in the Orthopedic Center at Boston Children’s Hospital.

Jonathan and his wife, Vonetta, bundled their young daughter and trekked to Boston, hoping that Waters might be able to help.

Michelle now has full use of her right arm

After examining Michelle and reviewing electromyography (EMG) and nerve conduction studies to measure Michelle’s muscle response, Waters recommended surgery to help Michelle recover function in her arm and hand. With Michelle tucked into Boston Children’s as an inpatient, the Patient Family Housing Program arranged for Jonathan and Vonetta to stay in housing near the hospital.

During Michelle’s six-hour surgery, Waters removed the injured nerves and used grafts from her leg to reconstruct those nerves (nerve grafts). He also re-arranged some nerves in her neck to help the right arm function (nerve transfers).

Michelle emerged from the operating room with a neck collar and her arm firmly bandaged to her side. Four weeks later, the bandages were removed, and Michelle returned to gentle motion therapy with her local PT in West Haven.

She proved to be a star patient, says Waters.

Michelle went from helpless to grabby, reaching for whatever was in front of her. “Every toy was her favorite. We could see her growing stronger,” says Vonetta.

Michelle continued to regain strength after surgery. “From 18 months to four years, she hit all the marks we expected, with continued improvement that exceeds regular growth,” says Waters. Unlike many children who undergo brachial plexus surgery, Michelle has not required additional surgery to recover.

More than four years after surgery, Michelle’s brachial plexus injury is nearly impossible to detect. “If you weren’t paying attention, you wouldn’t know she has an injury. She can hold a crayon, ride a bike and do most things that 4-year-olds do,” says Vonetta.

To learn more about Boston Children’s Brachial Plexus program, click here.