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Massachusetts BPI Specialists/Clinics
Peter Waters, MD
When was your Brachial Plexus Injury Clinic established? 1989 Identify what specialties related to brachial plexus injuries are represented by practitioners working in your clinic including physical/occupational therapists, if any. Physical therapy, occupational therapy, neurosurgery, neurology, orthopaedic surgery, plastic surgery, and most importantly, hand and microvascular surgery. What do you/your clinic specialize in treating? This program specializes predominantly in brachial plexus birth palsies and also traumatic brachial plexus palsies in children. Indicate the total number of brachial plexus patients you/your clinic has evaluated since your establishment: There are more than 400 patients a year with birth palsies seen and cared for. The number of children seen for traumatic injuries is less. At this stage I only see children and young adults through graduate school age with brachial plexus palsies. Otherwise I refer to the adult hand surgery service at the Brigham and Women's Hospital or Massachusetts General Hospital for older adults. State your philosophy regarding evaluation, referral and treatment of brachial plexus injuries in children. In essence, our clinical philosophy for evaluation, referral and treatment of children with brachial plexus injury is extensive and appropriate for the child's age and degree of problem. We utilize standard classified systems for each child, for each visit, care decisions are based on the infant's/child's problem and recovery status. Care includes microsurgical recommendations for those children between 3 and 6 months of age as appropriate; tendon transfers and corrective osteotomies for those children between 2 years and adulthood as appropriate. Extensive rehabilitation is utilized. We do extensive research on this including grant funded research through The American Society for Surgery of the Hand and the Pediatric Orthopaedic Society of North America for prospective studies on these issues in order to reach the best treatment option for all children. We present all of our research papers on a national basis and also publish these results in peer reviewed journals. The same obviously applies to traumatic brachial plexus injuries in children. The questions that refer to adults are not applicable for my practice. State your philosophy regarding pain management and brachial plexus injuries. In terms of pain management, we have a pain management service here at the Children's Hospital which is extensively involved in our program. Their program is recognized as the foremost authority on pediatric pain in the world headed by Professor Charles Berde of the Department of Anesthesia and Pain Service. At present, we are just completing a study on pain syndromes in brachial plexus birth palsies which is both retrospective and ongoing prospective in nature. Our results will be presented and published in the near future. Indicate research efforts (include dates please) conducted by you specific to brachial plexus injuries. As mentioned above, there are a large number of studies going on in this institution. These include prospective studies funded by the American Society for Surgery of the Hand and the Pediatric Orthopaedic Society of North America for evaluation of microsurgical indications in infants with brachial plexus palsy. It also includes prospective studies of glenohumeral deformities and results of tendon transfer operations about the shoulder for these children. Numerous papers have already been published and presented in these areas and will continue to be published prospectively. As mentioned above, we just completed a pain syndrome paper that indicates 3% of infants with Brachial Plexus birth Palsy have a significant pain syndrome requiring care. Indicate any other facts that you feel would help families and individuals understand your practice. If they desire, all the families and children participate in a parental and child support program now. We encourage them to utilize all other support programs on a national and international level. I/we encourage other care options. We believe that this is truly America and that people should choose what they feel is best for their child. 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. We are a pediatric hospital that cares for children from all states and throughout the world. At the present time, there are no limitations in terms of state Medicaid programs or insurance plans. |
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