An 11-year-old’s arm moves for the first time after innovative nerve surgery

The journey from Mozambique to India was meant to fight her father’s cancer. Eleven-year-old Ancha was only accompanying him. Her inability to raise her left arm or bend her left elbow since birth was not the reason for travel. For years, the family had learned to live with it. She wrote with difficulty, avoided playground games, and never knew what it felt like to use her left hand freely.One afternoon, between his consultations, her father took her for regular physiotherapy and asked the rehabilitation doctor, “Can anything be done for her left arm?” The doctor suggested, “Why don’t you meet the Plastic & Reconstructive Surgeons- they can help your daughter!”That casual question led to an evaluation and surgical decisions few attempt at her age, and to a moment the family says they will never forget.Ancha was born with left birth brachial plexus palsy, a condition since birth that affects left upper limb movement. Over time, there was a partial recovery of the hand, but as her shoulder and arm muscles grew stronger, they worked against each other. It’s called co-contraction, and it prevented her from bending her elbow and raising her arm. So she hardly used her left hand. Over 11 years, some muscles in her shoulder were permanently shortened (contracture), while the arm muscle length, the shoulder and elbow joint were preserved due to good physiotherapy. This condition in late childhood posed a challenge, but Dr Anil Murarka and Dr Mohit Sharma, the Plastic and Reconstructive surgeons at Amrita Hospital, Faridabad, saw an opportunity to innovate and provide a less invasive and permanent solution to make her left upper limb functional. Instead of the conventional method of injecting Botulinum toxin into a muscle group, usually ineffective at this age, the team performed highly specialised peripheral nerve surgery for elbow function, along with a modified tendon release & transfer to correct shoulder deformity. The surgery partly involved identifying the minutest of nerves under an operating microscope and lasted nearly five hours. "Restoring a balance between the opposing muscle groups in the shoulder and elbow with a patient and family-centric approach is the key in managing such Birth brachial plexus palsy cases. In Ancha, for elbow function, we used a combination of peripheral nerve and tendon release-transfer surgery tailored to address her problem of elbow co- contraction and shoulder contracture. We are excited to see the immediate results and will be following her up closely as her brain and arm 're-learn' and adapt. Cases like this are rare, even more special because the family didn't come seeking this treatment as they had been told there is no treatment, and we achieved visible results in days," said Dr Devajyoti Guin, Senior Consultant, Lead- Brachial plexus Surgery, Plastic and Reconstructive Surgery, Amrita Hospital, FaridabadOn the day after surgery, when doctors asked her to try bending her left elbow, Ancha hesitated. Slowly, her left hand moved upward toward her face. Her father watched silently. “We travelled because of my illness. But the biggest healing happened to my daughter. For the first time in 11 years, she lifted her hand herself. I cannot explain that moment.” In just 9 days after surgery, she was raising her hand above her head and using her left hand for activities of daily living.Addressing cases of birth brachial plexus palsy presenting in late childhood with lesser ability of the brain to adapt to changing movement patterns, is challenging and requires thorough clinical evaluation, precise diagnosis and specialised management tailored to each problem. A problem-solving approach using the available set of surgical techniques is essential.