makalajohnson (@makala johnson) published a blog post · August 8th, 2012
Injured At Birth
Ironically, little Taylor Rose Beauseau experienced what will likely be the most severe injury of her life during her birth. While emerging through her mother's birth canal, her right shoulder became trapped, injuring the nerves that control her right arm.
In most cases of brachial plexus injury during birth, the nerves are stretched and infants develop use of their injured arm in a month or two. In Taylor's case, the nerves were severed and, even after several months, she couldn't move her right arm. "When she was six months old, she had surgery to repair the damage, but she still wasn't able to move her right arm," says Taylor's father, Jason Boso. The family was concerned that Taylor would never be able to use her right arm.
"As parents, we always want to make the best choices for our children," says Jason. "So on my birthday, I gave myself a special gift and called Mayo Clinic in Rochester to see if they would be willing to evaluate Taylor. We definitely needed a second opinion."
An innovative technique
"It's difficult to see young parents in this situation," says Alexander Shin, an orthopedic surgeon at Mayo Clinic in Minnesota. "They're expecting this beautiful, perfect baby and something goes wrong during childbirth. You can't immediately see the damage, but it's there."
"Mayo Clinic feels like a very important place," says Jason, who is from the Twin Cities area of Minnesota. "When we first met Dr. Shin, he was with five physicians who all seemed so concerned about Taylor." Dr. Shin, who specializes in hand and microvascular surgery, developed an opinion about what might be done to help Taylor. "I wanted to confer with other specialists, which is one of the great benefits of working at Mayo," he says.
For Taylor's family, Mayo Clinic was more than an important place — it became an icon that brought ingenuity and results. "Dr. Shin took a very personal approach to Taylor's care," remembers Jason. "It was that extra effort, those extra explanations, and an experienced surgeon's gut instinct that made a monumental difference in my daughter's quality of life."
Had Dr. Shin repeated the nerve grafting technique used in the first surgery, it would have almost certainly failed. "You have only a certain window of time after an injury to get the nerves re-hooked — approximately six months to one year," explains Dr. Shin. "Outside of that, the nerves and muscles may never function properly." Taylor was dangerously beyond this window of time when she arrived at Mayo at 15 months of age. "We needed to get those nerves hooked up to allow them to start regenerating as quickly as possible," he says.
Dr. Shin and team used a novel approach called the Oberlin Technique. "We did three nerve transfers, borrowing a piece of her working ulnar nerve and relocating it to meet the nerve that runs to the biceps," explains Dr. Shin. This is a standard technique, but not normally done in pediatric patients. "Then, we transplanted part of the triceps nerve and used it to power the axillary nerve that goes to the deltoid or shoulder muscle," he says.
A third technique involved a standard nerve transfer, but harvested in an extended position. This nerve — the one that shrugs the shoulder — was used to reinnervate (power or rewire) nerves that weren't working in Taylor's arm.
Nerve grafting is done approximately 75 to 80 times each year at Mayo in both pediatric and adult patients. "This was a very unique and proactive approach that we took for Taylor because collectively our team determined it was the best chance for her to regain use of her arm," explains Dr. Shin.
Up in arms
With nerve transfers, it's a wait-and-see approach to determine if nerves will accept the new "signals" and begin functioning.
"Shortly after Taylor's surgery, she was laying on the floor and we saw her lift her right arm off the ground," says Jason. "It wasn't much, but it was the first time we ever saw her move that arm, and it was an incredible feeling." Since then, Taylor continues to make progress.
Taylor does part of her physical therapy on her own just by being a toddler and interacting with her older sister. "Whenever they're playing together, I see Savannah instinctively help Taylor to use her right arm instead of her left," says Jason. "Sometimes when Taylor won't listen, she asks us to get involved, but usually she can handle it."
"It was so upsetting and unsettling going through all this," says Jason, "but the folks at Mayo helped us offer Taylor a normal life. I guess you could say that our second opinion was our last!"
"Taylor may require another surgery to regain full elbow function, but we'll see how she does," says Dr. Shin. "So far, she's doing wonderfully."
Now, when Taylor Beauseau's parents see her "up in arms," it's a very beautiful thing.