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California BPI Specialists/Clinics
Michelle A. James, MD
Shriner's Hospital for Children, Northern California
Response to UBPN questionnaire:
NOTE: Only questions answered are included here
When was your Brachial Plexus Injury Clinic established?
1990.
Identify what specialties related to brachial plexus injuries are represented by practitioners working in your clinic including
physical/occupational therapists, if any.
Orthopaedic surgeon (hand & upper extremity), physiatrist, O.T., P.T., Child Life Therapy, Social Worker, Clinical Nurse Specialist.
What do you/your clinic specialize in treating?
Obstetrical and traumatic brachial plexus injuries in children under 18 years of age.
Indicate the total number of brachial plexus patients you/your clinic has evaluated since your establishment:
Number of children (Obstetrical brachial plexus injuries):
>400
Number of children (Trauma or other brachial plexus injuries):
10-20
Number of adults (Obstetrical brachial plexus injuries):
0
Number of adults (Trauma or other brachial plexus injuries):
0
State your clinic philosophy regarding evaluation, referral and treatment of obstetrical brachial plexus injuries in children.
I am a fellowship trained hand and upper extremity surgeon specializing in the care of children's upper extremity conditions.
I work for Shriners Hospitals full-time.
Shriners Hospital does not accept payment from any source for the treatment of children with obstetrical
brachial plexus palsy (or for any of the children we treat for orthopaedic problems, burns and spinal cord injury). Families must apply to Shriners Hospital
for care through our Referral Center; their phone number is 916-453-2190. Although our waitlist for this clinic is currently approximately 6 months,
we reserve appointments for new injuries (infants less than 6 months of age) and make every effort to see them within 2 months of application.
We follow infants with monthly exams, and recommend and perform nerve exploration and grafting for infants who are showing no signs of recovery in
key muscle groups by age 4-6 months. For children 2-4 years who have appropriate indications, we recommend and perform shoulder external rotation tendon transfers,
and for older children with appropriate indications we perform other tendon transfers and osteotomies (bone rotation surgery).
State your clinic philosophy regarding evaluation, referral and treatment of traumatic brachial plexus injuries.
Shriners Hospital does not accept patients with acute traumatic injuries other than burns, so initial care must be received elsewhere.
Otherwise children with traumatic brachial plexus injuries are treated similarly to children with obstetrical injuries. They are followed closely
for several months after the injury to determine if nerve exploration and grafting is indicated. We also provide later treatment, such as tendon transfers
and bone surgery.
State your clinic philosophy regarding pain management and brachial plexus injuries.
Children with obstetrical brachial plexus palsy rarely complain of neurogenic pain. Occasionally children with traumatic brachial plexus palsy complain of pain; our clinic
refers them to a pain management program, which is not offered at Shriners Hospital.
Indicate research efforts (include dates please) conducted by your clinic specific to brachial plexus injuries.
Our clinic is currently participating in a multi-center longitudinal study of infant recovery from obstetrical brachial plexus injury. With our Motion Analysis Laboratory, I am currently studying
how children with obstetrical palsy move their arms before and after external rotation tendon transfer. I have presented the results of nerve exploration and grafting, of shoulder external rotation tendon
transfers, and of motion analysis at several meetings and written about these topics for 2 textbooks. The motion analysis technique we have developed has been published, and I am currently preparing for publication
an article on the long-term follow-up of shoulder external rotation tendon transfers.
Indicate any other facts that you feel would help families and individuals understand your practice/clinic.
Shriners Hospital is a wonderful supportive environment. Because we accept no payment for our services, we can focus on providing what the child and family need rather than what insurance allows. We
routinely provide peer contacts (contact with other families who have had a similar experience) for families. We are not able to provide expert witness testimony for litigation purposes.
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.
Shriners Hospital accepts no payment from any source for any of the services we provide.
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