Dallas Cerebral Palsy, Erbs Palsy, Shoulder Dystocia Lawyers

Leading Treatment Centers for Shoulder Dystocia

& New Surgical Interventions

Part I - Texas Children's Hospital

Why Are Hospitals & Treatment Centers Ranked Differently?

 

There are many organizations, magazines and government agencies that rate and rank hospitals on an annual basis and release "Top 10" or "Top 50" lists. Many times, one facility will be listed on one agency's list and absent on a magazine's list. This common difference is not an oversight on anyone's part. Keep in mind that each agency, organization or magazines have different goals in completing their studies. For example, a magazine's annual review is obviously to increase sales of that particular issue while a government agency's review might be to determine public insurance reimbursement rates. Second, each "study" uses different criteria, or factors, in determining what count as "best." Many magazine ratings are based on surveys sent to physicians who often have a tendency to rate either the programs at which they studied or their current hospitals more highly than competitors. The criteria used by agencies and organizations are specific to the institutions' goals and requirements and may be almost entirely different types of measurements.

Why Are The Following Hospitals & Treatment Centers Considered Important?

This information is an informal and unofficial list of treatment centers that treat shoulder dystocia injuries. They have a reputation, however, among specialists in the field -- physicians, therapists, attorneys and others -- as leading treatment centers for some of the following reasons:

• They are the "home" hospitals of expert surgeons who specialize in the field.

• Regular advances in treatment are published in medical journals after the reports have been peer-reviewed, or approved after reviews by other experts in the field.

• The practicing surgeons and their research associates conduct regular studies to determine what types of treatments or what surgical methods result in the best prognoses, or future conditions.

• The medical center is the destination of surgeons seeking training in specific surgical techniques.

• The centers are home to sophisticated post-op treatment programs run by expert physical therapists and occupational therapists.

• A significant and strongly emphasized aspect of the post-op treatment programs involve parent or caretaker education to ensure that exercises are performed regularly and correctly after a patient returns home.

• Licensed Clinical Social Workers (LCSW) and Registered Nurses (RN) coordinate care between the facility and the child's family and a physician local to the family home. This type of long-term care coordination is an absolute necessity for care that frequently takes years to complete.

Texas Children's Hospital Contact Information

Texas Children's Hospital is both one of the country's largest medical centers and one devoted exclusively to pediatrics, the practice of medicine for children. Further, this treatment center offers multiple clinics and programs specializing in different fields of medicine, such as heart care (cardiology), kidney care (nephrology) or bone treatment (orthopedics). Often, a child referred for one medical problem will require consultation from another department, so the entire institution is designed to share information efficiently and without redundancy, or repeated and unnecessary tests.

How Does My Child Get Referred to Texas Children's Hospital?

An infant or child with a diagnosis of shoulder dystocia can be referred to Texas Children's Hospital in a number of ways. The infant may be born at the hospital if the pregnancy is identified as high risk for complications. A toddler who has not begun to utilize the affected limb may also be referred via:

The Pediatric Neurology Center;

The Pediatric Neurosurgery Center;

The Pediatric Neurophysiology Clinic; or

The Cerebral Palsy Clinic (when the shoulder impairment is clearly part of an overall diagnosis of Cerebral Palsy, or CP).

Either way, your baby's doctor can make the referral for you. Depending upon your insurance, you may also be able to make an appointment for your child to be evaluated for treatment at the center. There is no reason to worry that your child has been referred to the "wrong" clinic due to the constant communication and referrals back-and-forth between the clinics. Although the disorder may be new to you and your family, the employees in these clinics are experts in the field and will ensure that your child is ultimately seen by the correct group of specialists.

Where Do I Get Contact Information for Texas Children's Hospital?

The following information can get you started:

Texas Children's Hospital, Neurology Department

6621 Fannin Street
Houston, Texas 77030

Main Number/Patient Information

Toll free 800-364-KIDS (5437)
or 832-824-1000

 

Family Advocacy

832-824-1919

What Makes Texas Children's Hospital So Special?

According to the article, "Current Management of Obstetrical Brachial Plexus Injuries at Texas Children's Hospital Brachial Plexus Center and Baylor College of Medicine," by Saleh M. Shenaq, MD, et. al., as of 2005, the following was true:

The Program had been in existence for over 16 years (now 23 years);

Over 5,000 patients had been evaluated and treated;

 

More than 650 brachial plexus operations were completed in 2002;

Over 3,000 surgeries had been conducted from the program's beginnings through its first 12 years of operation;

 

"Virtually all patients have shown improvement in upper extremity active range of motion, with no loss of function in our experience."

All patients are treated with a multidisciplinary team that includes:

A dedicated pediatric neurologist

 

A pediatric neurosurgeon

Two reconstructive microsurgeons

A physical medicine and rehabilitation specialist

 

An electrophysiologist

A team of pediatric occupational therapists.

All the physicians on the team are full-time academic members of the Baylor College of Medicine

A continued dedication to research.

Texas Children's Hospital's Management of Brachial Plexus & Shoulder Dystocia Injuries

What Are Brachial Plexus Injuries & Shoulder Dystocia Injuries?

As your baby's doctor has probably explained to you, shoulder dystocia is a complication of labor and delivery that happens when a baby's shoulders are unable to pass through the mother's pelvis. In other words, the baby's shoulders are too large to pass through the mother's pelvis. For instance, gestational -- or maternal diabetes -- can cause babies to grow larger than expected and cause this complication. Attempts to delivery the baby -- by allowing a long labor, using forceps to turn and deliver the infant or using vacuum extraction to pull the baby from the birth canal -- can pull or twist a baby's arm enough to cause nerve injuries known as obstetrical brachial palsy injuries.

What Are Nonsurgical Treatments of Brachial Plexus & Shoulder Dystocia Injuries?

Texas Children's Hospital conducts the following initial evaluation processes on every single patient:

• A meticulous history
• A complete physical examination
• An obstetrical history with emphasis on the perinatal period, or the period just before and just following birth
• Parent queries about use of any instruments during labor and delivery
• Patient queries about their baby's hand, arm and shoulder motion following surgery
• Classification according to the British Medical Research Council muscle grading system
• Classification according to the Mallet system for older children
• Photography and videotaping of upper extremity movement
• Any and all specific functionality is graded pre-treatment
• A chest x-ray to assess for a other types of nerve injuries or a broken clavicle (collarbone)
• Shoulder x-rays and a CT scan to closely examine the nerve pathways and the shoulder joint.

Based upon the results of the testing noted above and a review by the multidisciplinary team, a patient undergoing nonsurgical treatment usually begins, consisting of:

• Aggressive physical therapy (including daily passive range-of-motion exercises throughout all the joints);
• Protective splinting to prevent injury for patients with flail wrists and elbows;
• Electrophysiologic studies to document and treat (the benefits of which remain controversial).

What Are Surgical Treatments of Brachial Plexus & Shoulder Dystocia Injuries?

Surgery is a complicated process and there are complex names for every type of anatomical (body) structure and every type of procedure. Further, there are many different reasons to perform surgery, some of which are known and apparent at the time the procedure starts. For brachial plexus injuries, however, a major component of the procedure is to evaluate by eye what type of, and the extent of, the infant's injury.

 

A neurosurgeon makes an incision along the collarbone to expose the roots, trunk and early branches of the brachial plexus nerve system;

The neurosurgeon then makes an anatomical drawing of the nerve system, including any injuries, such as neuromas, avulsions or ruptures;

As necessary, a nerve graft is prepared and used to replace the traumatic neuroma that occurs due to the brachial injury;

A physical medicine and rehabilitation service professional and the neurosurgeon will then perform an electrophysiologic assessment during surgery to measure the grade of nerve conduction in the area.

 

These interventions have allowed the surgeons to locate the specific area of injury and measure the percentage of conduction injury. Having discussed strategy throughout this time, "the reconstructive strategy formulated intraoperatively is then implemented."

 

How Are Brachial Plexus Ruptures Surgically Repaired?

 

There are at least nine different surgical strategies for repairing ruptures, depending upon the extent of physical damage (stretched, partially torn and completed tears), the location of the injury and the degree of nerve conduction as determined by the electrophysiologic test. If you baby's doctor has identified a particular strategy, you can read more about the procedure in the article upon which this piece is based, located at www.ncbi.nlm.nih.gov/pmc/articles/PMC2884743/.

Strategy 1: Erb Palsy for a Conducting Neuroma

Strategy 2: Erb Palsy for a Nonconducting Neuroma

Strategy 3: Total Plexus Injury (C5–T1 Rupture)

Strategy 4: C5 Avulsion/C6 Rupture

Strategy 5: C5 and C6 Rupture/C7 Avulsion

Strategy 6: Klumpke Palsy

Strategy 7: C5-C6 Avulsion

Strategy 8: Global Plexus Injury (C5 Rupture)

Strategy 9: Global Plexus Injury (C5-T1 Avulsion)

SOURCES:

 

(1) "Current Management of Obstetrical Brachial Plexus Injuries at Texas Children's Hospital Brachia Plexus Center and Baylor College of Medicine." Seminars in Plastic Surgery. 2005 February; 19(1): 42-55. By Saleh M. Shenag, MD, Arturo H. Armenta, MD, Forrest S. Roth, MD, Rita T. Lee, MD and John P. Laurent MD.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2884743/

(2) "Part 2. Distinguishing Physical Characteristics and Management of Brachial Plexus Injuries." Advances in Neonatal Care. 2005;5(5):240-251. By Kathleen Benjamin, RNC, MS, NNP.

http://www.medscape.com/viewarticle/514539