It is something that no mother wants to experience, yet it happens in one to three out of every 1,000 births.
As a result, after he was born, he had no movement in his left arm, and it hung limp at his side. His fingers were curled up, and his hand was stuck in a position pointing behind him. He additionally had very little movement in his fingers on his left hand, but his right arm and hand were unaffected. He started therapy when he was 3 weeks old to help him move his arm.
Erb’s palsy is most often the result of a difficult delivery when the infant's neck is stretched during the birthing process. The resulting damage to the brachial plexus, a network of nerves near the neck, causes arm weakness and loss of motion, and possible paralysis of the shoulder, arm, hands and fingers.
Through parent social media groups, Kruz’s mom, Briana, learned about Scott Kozin, M.D., from Shriners Children’s Philadelphia, a leader in treating this condition. He has spent his career specializing in brachial plexus injuries and has written more than 100 peer-reviewed papers, many covering this type of injury. Therefore, Briana knew she and her son were in good hands before she even set foot in Shriners Children’s Philadelphia.
After their first appointment with Dr. Kozin, Briana said she “loved him” and felt “very comfortable” with him. She said she knew she wanted Kruz to be under his care. He had his first appointment when he was 1 month old in June 2024. Kruz followed up with Dr. Kozin on a monthly basis to determine if surgery would be necessary.
It was decided that Kruz would need a closed reduction surgery on his left shoulder after the humeral head, or ball, began slipping out of the socket, a condition known as subluxation. The surgery was performed when Kruz was 6 months old to push his shoulder back into place. Dr. Kozin also injected botulinum toxin into Kruz’s internal rotators to temporarily weaken his internal rotation so that, with physical therapy and stretching, his arm could gain external rotation over time. Dr. Kozin said, “Surgery was successful to realign the joint.”
After his initial surgery, he was fitted for a spica cast, which was used to hold his joint in place. Unfortunately, due to the severity of Kruz’s Erb’s palsy, Dr. Kozin had to operate again when Kruz was 9 months old due to humeral head subluxation. Kruz then had an open reduction surgery and a nerve transfer, and after surgery, was in a spica cast again for another four to six weeks. That was his most recent surgery. He is now six months post op, and his shoulder has not come out of place.
Briana said she feels reassured that the Shriners Children’s Philadelphia team consistently conducts ultrasounds at every appointment to confirm everything is healing properly. She also showed her appreciation not only for Dr. Kozin but also for Eugene Park, M.D., who surgically administered Kruz’s sutures, which healed beautifully.
The quality of care at Shriners Children’s Philadelphia has been very thorough, and the staff are personable, caring and dedicated to what they do.
However, it was not just the surgical side of Kruz’s care that left Briana satisfied with Shriners Children’s Philadelphia. Within the rehabilitation team, the occupational therapists (OTs) went above and beyond to support Kruz and his recovery from surgery. The OTs took measurements of his arm and fitted him for his nighttime brace needed directly after surgery. Due to his progress from OT, he no longer needs to wear the brace. Briana emphasized that the team made sure she was comfortable asking questions during any step of the process.
Right after his nerve transfer surgery, Kruz had OT two times a day and underwent intensive therapy practices. Briana then began to make regular trips to Philadelphia to see the OTs at the hospital instead of her local outpatient facility. She said she felt more comfortable continuing therapy at Shriners Children’s after surgery due to the severity of her son’s case and recurring shoulder issues. She chose to go once a week and said this also made it an easy way to communicate with Dr. Kozin if she had any concerns. Now, Kruz has follow-up appointments every few months with Dr. Kozin to make sure he is still healing properly. Kruz is now back in outpatient therapy at his local facility, along with Early Intervention services at home to aid in his recovery.
Today, Kruz is 16 months old and has more external rotation of his left arm than ever before. Prior to his surgeries, he couldn’t move his arm outwards to the side at all. “He would cry in pain if you put his arm in a 'high 5' position,” Briana said. “Now, after surgery, he can successfully move his arm actively and passively.”
Due to nerves naturally healing slowly, Kruz and his medical team are still waiting to find out if he will be able to put his hands above his head. However, in the meantime, he has improved fine motor skills: he can feed himself, clap, give high fives, and reach his arm out to the side. Due to his injury, he was never able to crawl and bear that much weight on his arms, so he adapted by scooting on the floor to get around. In therapy, the team would work on crawling with Kruz, but it was difficult for him. Therefore, he bypassed crawling and started walking at 14 months. “He’s come such a long way,” Briana said.
“The quality of care at Shriners Children’s Philadelphia has been very thorough, and the staff are personable, caring and dedicated to what they do. The peace of mind knowing that you’re in good hands really helps you get through the difficult times,” Briana said. “Knowing I was seeing Dr. Kozin, someone who is really good at what he does, helped me know I was in good hands. I hadn’t felt that way before.”
One of Kruz’s nicknames is “Nemo,” and his family calls his injured arm his “Lucky Fin.” They have additionally referenced “just keep swimming” throughout his journey, just like the motif throughout the film Finding Nemo. Coincidentally, Kruz loves water and swimming. Soon, he will be splashing around with both arms as he continues to regain mobility and rotation in his “lucky fin.”
Kruz lies in his crib, with one arm up and the other arm curled behind him.
Kruz squeezes his stuffed bunny toy.
Kruz holds hands with his brother, Kasen, at his first birthday party.
Kruz gives a thumbs up while wearing sunglasses.
Kruz stacks toys in therapy.
Kruz makes music with a toy keyboard.
Kruz uses both hands to play with a toy.
