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India BPI Specialists/Clinics
Anil Ghanshyam Bhatia
When was your Brachial Plexus Injury Clinic established? Started work on brachial plexus injuries in April 1995. Identify what specialties related to brachial plexus injuries are represented by practitioners working in your clinic including physical/occupational therapists, if any. I involve a neurophysician for electrophysiological evaluation and pain management and team of physiotherapists. What do you/your clinic specialize in treating? So far, I treat mostly adult palsies at this clinic although I do have experience in the management of obstetrical palsies and usually treat 3-4 cases a year. Indicate the total number of brachial plexus patients you/your clinic has evaluated since your establishment: As indicated above, I have operated on 140 cases of brachial plexus injuries in adults till today. State your philosophy regarding evaluation, referral and treatment of obstetrical brachial plexus injuries in children. Obstetrical Palsies: From the first referral (1st or 2nd day), I instruct gentle passive range of motion exercises. I note the clinical condition on the first day and review weekly. If the biceps does not show any evidence of recovery at 3 months, I advise a EMG examination. If that, too, is negative, I advise nerve reconstructive surgery. However, I have not been able to convince the parents of even one child for surgery in the last 7 yrs. State your philosophy regarding evaluation, referral and treatment of trauma or other brachial plexus injuries in children and adults. Traumatic palsies in children and Adult palsies: For supraclavicular injuries, I plan and perform nerve grafting or nerve transfers as early as possible i.e. if the patient comes to me within a week after the accident, I usually operate at 5 weeks from the date of injury. The details of surgical strategy are available on my website. For infraclavicular injuries, I usually wait for the clinical picture to become clear. In my experience, most such injuries have involved the axillary, musculocutaneous and radial nerves. In the absence of recovery along these nerves, I perform nerve grafting with excellent results.The surgery is usually performed at 3-4 months after the accident. State your philosophy regarding evaluation, referral and treatment of obstetrical brachial plexus injuries in adults. For sequelae of untreated obstetrical palsies, I have been used to performing osteotomies of the humerus combined with transfer of the teres major to the infraspinatus for restoration of external rotation of the shoulder, Zancolli's re-routing of the biceps tendon for correction of supination contractures and extensor tenodesis for extension of the fingers and the wrist.These surgeries are usually performed between the ages of 6 and 9 years. State your philosophy regarding pain management and brachial plexus injuries. My neurophysician prefers to prescribe tri-cyclic anti-depressants such as Amitryptylline for deafferentation pain in brachial plexus injuries. DREZ surgery is not available here. Indicate research efforts (include dates please) conducted by you specific to brachial plexus injuries. I have presented my results in adult palsies at conferences in Bombay (1996, 1997, 1998, 2002), Indore (2001), Ahmedabad (2001) and Bhavnagar (2001). I also presented the results of my study of sensory recovery in 18 operated cases of complete supraclavicular brachial plexus injuries at the 6th conference of the International Federation of societies for the Surgery of the Hand at Helsinki in July 1995. The patients shown had been operated upon by Prof. Christophe Oberlin of Paris. Do you accept any national/governmental payment for services or are you enrolled in any state medicaid plans? Please provide information on these plans and include which states you are enrolled in for medicaid services. I consult at a private trust hospital. There is no system of social security in India. Hence, the patient has to pay for his treatment at this hospital. The total cost of surgery at this hospital varies from 50000 Indian rupees (approximately 1000 US dollars) to 120000 Indian rupees (approx. 2500 US dollars) depending upon the class of room occupied during hospitalisation. This includes my fees (usually 25% of the total). |
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