Stretch BPI from unrelated surgery

[miserbank0312]

In Oct., I had a 5 level cervical laminectomy. Upon awakening from the 7 hr surgery, I had tremendous pain in my right arm. I had a very weak left arm and a weaker right arm with complete paralysis of the right deltoid. Other muscle functions are fine. After two EMGs, it was discovered I had a stretch "traction" brachial plexus injury. I also have incredibly painful neuropathy in right index finger only. On my own, I have scheduled an appt. w/ Dr. Mackinnon in St. Louis on 1/25 and an appt. w/ Dr. Spinner at Mayo on 3/13. It has now been 3 months since the injury. Other muscles in right arm are gaining strength. I am 45 and in otherwise excellent health and I am very athletic. What can I expect? Nerve transfer?

[ptrefam]

I think what you could expect depends on the injury. If it is a stretch, I am thinking time and therapy. But depending on weather or not there is nerve transmissions they may do a graft. When they went in my sons shoulder there were no avulsions so they cleaned out scar tissue and decided not to do the graft as all nerves were firing. They felt that a recovery without the graft would be best. It has been 14 months since his injury and he has gained strength but no functional movement. Now they are considering a muscle transfer. But they are still thinking it is just time and work and that the operation is a last resort. Nerves repair themeselves at a rate of about an inch per month, so it does take quite a bit of time. Forgot to mention Dustin was seen at Mayo, we've been back 3 times so far. They started with an extensive EMG 2 hours, then an MRI. You are doing the right thing by getting to a BPI specialist. But wondering if you have done any therapy yet.
Sue


Message was edited by: ptrefam

[miserbank0312]

I have had no therapy yet. Just started this week seeing a rehab doctor who conducted a very thorough EMG. Still awaiting his recommendations. I have read on this forum where incidents like this have on occaision not recovered by merely waiting. I don't want to let too much time elapse as my deltoid is completely without function and atrophy scares me. I was told after a certain amount of time, recovery will be less than 100%. I simply want options. Any suggestions or info would be appreciated.

[ptrefam]

Best time for a nerve graft is in the 1st 6months. You are seeing the best in the field. Only they will know for certain. The EMG should tell if the nerve is firing for the deltoid. Dustin's first EMG nearly every nerve was listed as severely abnormal. He had no movement other than hand. When we went to Mayo, at 6 mo post accident, they went in and did an EMG with it open. All nerves were firing so they did not do the nerve grafts. They said he would have the best recovery if they left it alone to heal on it's own. All muscles are gaining now, but very slowly. Still no functional movement. I think for deltoid they have him lay on his back and do like angel wings, like when u make snow angels. We have to put a piece of cardboard under his arm as he can't move it on the carpet yet. But he continues to raise it higher. He can also raise it overhead in water, so this is good therapy also. Good Luck!!

[miserbank0312]

Given it is only my deltoid that is not receiving any motor nerve action, would a nerve transfer be in order? Other neighboring muscles seem to be ok, just a little weak.

[ptrefam]

These are very good questions, but no one other than the dr could tell you that for certain. The hard thing with this injury is each one is different, even if they seem very similar. From what I have seen most of the grafts are for severely damaged nerves (avulsions and tears). This is not to say it is out of the question. Sometimes there is a blockage from other things such as scar tissue and once that is removed it will heal. I only know that when my son had no avulsions or tears the team at Mayo decided to let it heal on it's own. They felt this would be best. Dustin had no movement at the time. Nearly the whole arm was affected. Now his tricep has returned, bi is very weak, scapula, pec, ect. is mid range, but still no function, that is why they are thinking of a muscle transfer for the bicep. If he had that the arm would be functional. When he is on his side or in water he can move the arm nearly as though it is not injured. I know this is a very hard thing to deal with. But it will totally depend on what signals are or are not getting through. E-stim will help to exercise the muscle to slow atrophy. Exersizing it in water is also very good. Taking out the gravity so that hopefully you can move it then slowly adding weight as it gains. I think it was nearly 4 mos post accident before there was even a flicker in Dustin's bicep. We had him exercise this with a skate board type thingy so there was no gravity or resistance. Important thing was to get it moving, then to worry about strengthening when he had movement. I also suggest getting a scrip for a therapist. Keep us updated and let us know what they find.
Sue