Modified Quad Surgery

The Modified Quad (Mod Quad) is performed on patients from 6 months of age well into adulthood. Persistent contractures of the shoulder and chest impair growth and development often leading to further pain and movement limitations; so the Mod Quad is recommended early in life. 

Tightness in shoulder joint and inability to raise the effected arm over head are both commonly present in patients with obstetric brachial plexus injuries (OBPI). The Modified Quad procedure is recommended to decompress the axillary nerve and release the contractures in the lattissimus dorsi, teres major, subscapularis and pectoralis muscles. The latissimus dorsi and teres major muscles are sutured to a low position in the teres minor muscle; this enhances the stabilizing effect of the rotator cuff, enabling the deltoid to act more effectively while not tethering shoulder abduction and flexion ability. The result of this is dramatic improvement in abduction. 
The Mod Quad surgery  is about a 1 hour procedure. Patients stay for one night in the hospital to ensure proper splinting and positioning of the arm. You will be given detailed instruction on post-operative care upon discharge.


Children under 6 years of age will be splinted in a “statue of liberty” position for 2-4 weeks. It is half torso, rigid body splint maintains the position of the shoulder at 120 degrees oriented laterally (to the side as shown above). The elbow and wrist are well padded to protect the ulnar nerve. The arm is splinted in such a way to encourage motion at his height. Later, it may be worn for an additional four weeks at nighttime only. During the post-operative phase there should be no internal rotation movements until clearance is given by Dr. Nath. When splint is no longer worn at night, regular physical therapy and occupational therapy should be resumed, gradually and as tolerated.


Children 6 and older as well as adult patients will not be placed in a splint. They will be instructed on how to keep the arm immobile. In some cases a pillow may be provided to help with this. 


  • 1. Evaluation in Houston office (no charge for initial consultation)
  • 2. Telemedicine, submit all medical records to the office with video 
  • 3. Outreach Event evaluation for in person evaluation free of charge( must bring documentation if required for condition)


Infants can be evaluated by video, simply remove clothing to the waist and show spontaneous movements of both arms while lying on the back. You can of course also have your child evaluated by Dr. Nath in person. Please visit and sign up for our email list to see when Dr. Nath will be in your area next.  

We also able to schedule a visit with Dr. Nath in Houston, please contact our office at 713-592.9900. 

In the interim, please contact our staff therapist Cindy Servello. via email at  She will contact you and would be happy to answer any questions you might have.  


We also need to see any medical records pertaining to your child’s injury, specifically previous surgical reports, CT or MRI reports and images, and EMG (nerve conduction study) results. The records may be faxed to 713-592-9921, emailed to, or mailed.

Please also fill out, sign and submit the Consent Form .  This must be included with all documentation prior to Dr. Nath's review of the records.


Please send us a video or photos showing you/your child’s current range of motion using the movement chart shown.  All movements should be included with a maximum of 30 seconds time. Please have someone film you/your child wearing a tank top or sports bar, so that the shoulder blade is visible.

Videos taken on camera phones may be emailed to Videos taken on regular video cameras may be uploaded to our website due to large file size. 

Click below for video upload: