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news item News Friday, October 19, 2018 Friday, October 19, 2018 10:38 AM - Friday, October 19, 2018 10:38 AM

Patient with acute flaccid myelitis (AFM) visits for one year follow-up after nerve transfer surgery

After AFM diagnosis, patient sought treatment at Shriners Hospitals for Children — Philadelphia

In August 2016, at age 7, Talon was not feeling so well. He went to the emergency room and was diagnosed with a routine sinus infection. He woke up the next day with pain and was unable to move his left arm. His mother, Rachel, remembers that Talon had no motion whatsoever in his arm. He was able to move his legs. She quickly returned with her son to visit the emergency room. Doctors did a full work-up but could not find anything wrong or make a diagnosis.

Talon stayed at the hospital for two weeks. During that time, he started therapy that included electrical stimulation, steroids and antibiotics. He had some improvement with his symptoms. He gained some movement in his elbow, fingers and wrists. While in the hospital, Talon was diagnosed with acute flaccid myelitis (AFM). Children will often present with rapid onset of weakness on one side, often rapidly progressing from normal strength to profound weakness with loss of reflexes within a few hours to days. Rachel learned about Shriners Hospitals for Children—Philadelphia through an AFM support group on Facebook.

Rachel called to make an appointment to see two of the top upper extremity pediatric orthopaedic specialists in the U.S., Dan Zlotolow, M.D., and Scott Kozin, M.D. Soon after speaking with the staff at the Philadelphia Shriners Hospital, Talon was scheduled for an initial appointment in September 2017. At this visit, Dr. Zlotolow and Dr. Kozin did a complete exam to review Talon’s movement and strength. Although he had regained some movement in his wrists and hands, he was still unable to straighten his fingers and the muscles in his hands were weak. The team decided on a plan for nerve transfer surgery that would help Talon to regain as much function as possible.

Nerve transfers work by moving a working nerve that has a redundant function to a non-working nerve that has an important function. Nerve transfers have been used to restore function after injuries to the nerves in the arms since the 1920s. The advantages of nerve transfers are that they have the potential to provide increased control of the arm and more muscle recovery than other procedures such as tendon transfers. Nerve transfer surgery must be performed as early as possible for best results, ideally within six to 12 months from the date of injury. Early consultation with a specialist is necessary when considering nerve transfers for improved function.

On October 16, 2017, Talon entered the operating room for his nerve transfer surgery. The goal of the procedure was to give him more function in his elbow and fingers. He had no available nerves to help restore his shoulder function. After his surgery, Talon completed occupational therapy to help regain movement.

In April 2018, at his six month post-op appointment, he was starting to straighten his fingers and had some improved movement in his deltoid muscle. He was also starting to gain some function in his rotator cuff. Talon’s family was very pleased with these results. He continues to make improvements with the nerve transfer surgery.

Now one year post surgery, Talon, 8 years old, returned to see Dr. Zlotolow.

“His hand works well,” said Zlotolow. “He can open and grab now, which is huge. His elbow may need further surgery. We’re going to watch it for another year.” Talon recently discovered he can play pinball machines, in addition to his video games at home.

Talon is one of several patients with acute flaccid myelitis that Dr. Zlotolow and the team at Shriners Hospitals for Children — Philadelphia have seen.

 
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