TBPI

[admin]

Just wanted to share some thoughts on traumatic brachial plexus injurys.I was in a motorcycle accident aug 6 02.I sustained several injurys in the wreck such as a broken neck C5 C6 C7.Also had to undergo reconstructive facial surgery on right side of face,which included several pieces of titanium around eye socket.Also had broken both femurs,compound fracture on right leg below the the tibelia plateau which also involved sveral pieces of metal.The last one to mention is traumatic brachial plexus injury with possible root avulsions to C5 C6 C7 and T1.I uderwent 10 surgeries during the whole month I remained in the hospital. At home I had several visits back to the hospital concerning the severe injurys and started therapy with my leg still did not know what was going on with my arm and did not Know it was this complicated.Had the first emg study done around the middle of october.the following week I met with Dr John Buerger which is part of the Plastics team under Dr. Kevin Yakenboff At the University Of Cinncinati Hospital.Meeting with Dr. Buerger was the first time I heard one of the doctors I had seen for TBPI who actually knew anything about it and gave some options of some surgeries that I could undergo and encouragment about what the possiblites for recovery were.I then met Dr.Yakenboff.His evaluation was very impressive I am very confident in their ability to perform my surgery which is scheduled for January 13 at U.C. I dont know all the details yet but meet with him and his team on January 8 to find out more. I have very little feeling in my thumb and the underpart of my forearm that has just returned in the last few weeks.I have no motorskills from the elbow down have a little bit of use in my brachial radiualis which is under the bicep.There are some muscles in my shoulder that work and I have most of the feeling in my upper arm and shoulder. Have seen some improvment but not much. I started hand therapy with a team at U.C. on November 1 which gives me some encouragment to my recovery.There main concern was that it had been almost three months since the accident before I had any kind of therapy which is with them.I had not done any kind of streching or any type of movement with the fear of making the injury worse becuase of not having any real infomation about TBPI.My shoulder was locked up because of this.With twelve visits in the last two months to the hand therapy team which were painful sometimes I have regained most of the flextion back in my shoulder.I am also using an E stem unit which is supposed to send electrical shock pulses to the nerves to try to regenarate them. Seems to be that one of the worst things that happens in most cases of TBPI is that there is usually more severe injurys that have to be dealt with first. The way Dr. Yakenboff explained it to me is that there is a window of opportunity that you have to look for to proceed with surgery if it is necessary in some cases it is not and people recover almost totally without surgery, but that is not so in my case.Still they like to wait a little while to see how much of the nerves will regenerate on their own.Some of your recovery lies in the hands of your surgeons and some in your therapist hands but the majority lies in yours.I have a long recovery ahead of me possibly a year or longer.I have had my days but still am confident of overcoming this with no dissabilites if you are going thru the same or similar situation feel free to email me at hdcrash@aol.I will try to keep this up to date after the surgery to give somebody else hope of recovery.

[athos]

hi hdcrash,

I read all ur messages. Very good luck to u. It sounds as if u are in good hands.

The road to recovery can be very slow and very long, but also very satisfying if u get good recovery, as in my case. Though, in my case it only has become satisfying after 2 1/2 years, because only after that time was my arm responding in a good way. Now after nearly 3 years anything more I get back is a bonus. And it hasnt stopped to get better. So, I consider myself a success story.

I hope u get loads of movement back. But from this board u will find out that the amount people get back varies dramatically depending on severity of injury. It varies from amputation (worst case scenario) to almost total recovery.

Keep us up to date with ur progress, and all the best to u.

Athos

[hdcrash]

Athos Thanks for the reply.Did you go thru surgery if so what type or did you try on your own.What were your injurys and how severe if yuo dont mind my asking.Thanks for the support and I will try to keep everyone informed on my progress after surgery.

[athos]

I had accident (run over by taxi) in Jan 2000. I had exploratory surgery in Feb 2000. I damaged mainly the posterior chord which biforcs into axillary and radial nerves. However my nerves were in continuity. The surgeon said he could have done something about it, but preferred to leave everything as he found it, which was a great idea, because I get the impression that if surgeons can avoid fiddling with nerves the better. In my case the nerves were in continuity, not torn or avulsed, so the surgeon could avoid touching them. In some cases, when nerves are in continuity, some surgeons perform neurolysis, which means removing scar tissue that has formed around the nerve, but I personally think it's a waste of time, although I'm no doctor I mean if the body generates scar tissue, then surely it is there for a purpose, and it is not to be removed. Does the surgeon know better than the body? I don't think so.

Then in jan 2002 I had tendon transfer surgery to forearm to restore extension of wrist and fingers and thumb. Basically the function of the radial nerve below the elbow had not recovered, so I had typical wrist drop and hand that would not open up. So, tendon transfer surgery was done to get my wrist to neutral at least, and to allow my hand to open before gripping things. This surgery is a standard procedure, and the results have been very good.

So, those are my 2 bpi surgeries. I'm now done in terms of surgeries.

[hdcrash]

Hey Athos Good to here from you again That comment you made about doctors knowing more about the body than the body I agree 100% and oddley enough so does my doctor in some ways he had a few emgs and a mri done on me but didnt read them until after he examined me then discarded them because he said you could tell more by looking at the person than the studies the body dosent lie but the tests can be wrong sometimes.Did the tendon surgery hurt,and how soon can you tell the results

[athos]

No the tendon surgery didnt hurt. It is a standard procedure for people with radial nerve deficit. I kept my hand and forearm in a plaster for 6 weeks after surgery, and then I commenced gentle physiotherapy, which gradually got more intense.

To start with I was not happy with the surgery because my transferred muscles were not working well. But after a while (over 6 months) the transferred muscles started to function much better, and the benefits from the operation became huge.

Now I'm about a year post-surgery, and I have active wrist flexion and extension (just beyond neutral). The wrist is supple. Ok, it's not normal strength, but it's pretty good. The hand (fingers and thumb) opens nicely before gripping things, my grip is very strong. All in all a very good surgery.

The docs were very confident about this surgery, and they told me it always worked. But in my case the muscles took a while to really start functioning.

I only got some pain during the 1st few days after they removed my plaster when my hand/wrist was a bit swollen and sore. But that goes away as the hand/wrist heals.

[admin]

Hey Athos Thats Great I am Glad itworked out for you.Its very strange because I have never heard of this type of injury before I got mine and several doctors I saw didnt know much about it or the surgery options either.Keep up the progress and let me know how you are doing.Also if you dont mind my asking did yhey move muscles and tendons from anoyher spot or use the closest ones that still worked. Thanks Chris

[athos]

What they did was to move flexor muscles of hand/forearm innervated I think by median nerve to perform extensor movement, which was not performed by usual muscles innervated by radial nerve (radial nerve palsy). So the result is that I have lost slight flexor movement because some of those flexor muscles which were functioning normally have been transferred to do extensor movement. Thats more or less it. I don't know much of the technical stuff. I know that the pronator teres is now extending my wrist. I cant remember what tendons extending my fingers are called.

So to answer your question they used flexor tendons/muscles present in hand/forearm.

[hdcrash]

hey good to here from you again sorry it took so long to reply. Had surgery 1/13/03 gotta wait 3 weeks to start therapy.Since my injury was so severe they are already talking about other options