Hi folks, Michael here. Right arm BPI injury May this year. I am curious as where in the arm everyone gets their pain. Mine is generalised to the fingers and thumb. Usually don't get much up the arm only the occassional weird sensation, not really pain. Sometimes get a pins and needles sensation up the arm. The pain in the hand is a burning pain.
Usually get a few goods days with bearable pain, then all hell breaks loose and I seem to get a couple of days of extreme pain where no matter what medication I take it does nothing. Regards Michael
Curious as to where u get the pain
-
admin
- Site Admin
- Posts: 19873
- Joined: Mon Nov 16, 2009 9:59 pm
-
Too Much Metho
- Posts: 12
- Joined: Sun May 30, 2004 2:14 am
Re: Curious as to where u get the pain
Yeah that sounds very similar to mine Michael. I can relate to the weird feeling in your arm that's not pain, actually I look forward to it. It's like, hey, that's a change, this is relatively pleasurable by comparison. Then it stops just as I'm getting into it...
-
cbe411
- Posts: 1393
- Joined: Sun Jun 01, 2003 8:27 pm
- Injury Description, Date, extent, surgical intervention etc: MVA in 2001, nerve graph in 2002, Median Nerve Transfer in 2004 and an unsuccessful Gracillis Muscle Transfer in 2006. I am living life and loving it! Feel free to contact me :)
- Location: Grosse Pointe Woods, MI
- Contact:
Re: Curious as to where u get the pain
I agree the only pain that I get in in my hand, nuckles to be exact. I say ONLY likke its a tiny but of pain, the past week has been HELL for me! Pain in the nuckles is out of controll! I get funny sensations in my upper arm but I really think they come and go wit hthe regteneration of the nerves......
Re: Curious as to where u get the pain
11 years TBPI--fingers, thumb, wrist. When I have real bad episodes the pain "migrates"--it can go up my arm,,into my shoulder, the side of my head/neck, down rib cage and even into my hip. It's CONSTANT in my hand, fingers etc--even tho I had my arm amputated above the elbow 7 years ago. (more for convenience than anything-I knew it wouldn't stop the pain)-------------------------------------------------- Ronin
-
Gayle Ozzy
- Posts: 44
- Joined: Sat Aug 28, 2004 6:09 pm
Re: Curious as to where u get the pain
Hi Micheal,
I am so glad to see you posting on this website and am glad that it is helping. I know I get a lot out of reading peoples posts and knowing that there are so many people that know what we are talking about and feeling.
Where do I get the pain? Well predominantly thumb, fingers or hand. It seems to concentrate on different areas at different times. Occasionly I get a really bad on that goes up my forearm a bit. It's nasty. The pain seems to either be a stong constant pins and needles type pain that gets stronger, then fades, then stronger again etc, or it is a serve stab or contraction that just knots or spasms your hole body for a few seconds, then lets go, and then bang again.
I find sleeping a problem. I can't lie on my amputated side for any length of time so it's the bpi side (can't sleep on back). It just get's so uncomfortable after a while, it feels like someone is driving a knife through the side of your neck.
Anyway hope this helps. Great to hear from you and you mum!
I am so glad to see you posting on this website and am glad that it is helping. I know I get a lot out of reading peoples posts and knowing that there are so many people that know what we are talking about and feeling.
Where do I get the pain? Well predominantly thumb, fingers or hand. It seems to concentrate on different areas at different times. Occasionly I get a really bad on that goes up my forearm a bit. It's nasty. The pain seems to either be a stong constant pins and needles type pain that gets stronger, then fades, then stronger again etc, or it is a serve stab or contraction that just knots or spasms your hole body for a few seconds, then lets go, and then bang again.
I find sleeping a problem. I can't lie on my amputated side for any length of time so it's the bpi side (can't sleep on back). It just get's so uncomfortable after a while, it feels like someone is driving a knife through the side of your neck.
Anyway hope this helps. Great to hear from you and you mum!
-
jennyb
- Posts: 1183
- Joined: Fri Nov 02, 2001 5:24 pm
- Injury Description, Date, extent, surgical intervention etc: January 1980 Yamaha RD200 vs 16 wheeler truck, result, 1 totally paralysed right arm. I was 21, now 54. I had no surgery, I don't regret this. Decided to totally ignore limitations (easily done aged 21) adapted very quickly to one handed life, got married, had 3 kids, worked- the effect of the injury on my life (once the pain stopped being constant) was minimal and now, aged 54, I very rarely even think of it, unless I bash it or it gets cold, then I wish I'd had it amputated :) Except for a steering knob on my car, I have no adaptations to help with life, mainly because I honestly don't think of myself as disabled and the only thing I can't do is peel potatoes, which is definitely a good thing.
Re: Curious as to where u get the pain
I don't get the real take your breath away deep fat fryer stuff that often any more, when I do it's always in the base of my thumb and the palm of my hand. I sometimes get shooters up as far as the elbow. Sometimes my hand feels like it's clenching hard enough to put my nails through the palm, that's when I use a mirror box. I also get buzzy aches where some of my breaks were, especially the humerus which I broke again after the tbpi. Then there's the neck/shoulder/back joint achy pain that has appeared over the years and surfaces when I sleep wrong, have a cold/virus or when the barometer drops, which is quite nasty until I get a real tbpi spasm in the palm of the hand, compared to that the joint stuff just feels like a walk in the park! Both the hot fat fryer hand stuff and the joint/bone stuff will happen more if I am stressed, sick or when the weather's bad.
Wow that looks pretty bad written down, but really, pain bad enough to make me stop what I'm doing is rare for me now.
Jen NZ
Wow that looks pretty bad written down, but really, pain bad enough to make me stop what I'm doing is rare for me now.
Jen NZ
-
Karl w/ a K
- Posts: 154
- Joined: Mon Sep 15, 2003 8:48 pm
Re: Curious as to where u get the pain
Jenny,
That's why I don't write it down or think about it. For some reason, if I think about it, it hurts more. If I'm busy it does't bother me much. But when I stop to think about it, it hurts more. It really helps me to stay occupied....Karl....
That's why I don't write it down or think about it. For some reason, if I think about it, it hurts more. If I'm busy it does't bother me much. But when I stop to think about it, it hurts more. It really helps me to stay occupied....Karl....
-
admin
- Site Admin
- Posts: 19873
- Joined: Mon Nov 16, 2009 9:59 pm
Re: Curious as to where u get the pain
BRACHIAL PLEXUS INJURIES
Having coped well through their childhood and young adulthood with the injury, some adults as they age may start to experience long term problems in their affected arm and overuse symptoms in their unaffected arm. Family doctors in many cases do not realize that these problems may be specifically related to the brachial plexus injury. It may be extremely beneficial for these adults affected by brachial plexus injuries to seek help from a specialist even in later life. In addition, the many years of existing with the injury make these adults a valuable information resource in themselves, especially for parents of newly injured babies and also for adults who have suffered a traumatic brachial plexus injury. Finding a support group can therefore be extremely helpful. Just finding that there are many others facing similar challenges can be very comforting for those who have suffered alone for so long.
I Richard Khamani have sent this to you on sht notice ,giv me a little time, but contact me at jerryjkd@yahoo.com to remind me.
Good Luck
Injured associate.....
TRAUMATIC BRACHIAL PLEXUS INJURIES
Brachial plexus injuries caused by road accident or other physical trauma are known as trau-
matic brachial plexus injuries (TBPI). These are devastating injuries that sometimes do not recover spontaneously or respond well to treatment. For this reason, expert specialist help should be sought as soon as possible after diagnosis. As the causes of such injuries are often violent, such as road accidents, gunshot or knife wounds, establishing and treating other, possibly life threatening injuries incurred at the same time is often the priority immediately post trauma. Sometimes there can be a delay in the detection and treatment of the brachial plexus injury because treatment of these other, more immediately serious injuries has to take priority. Once any more dangerous conditions have been identified and stabilized, the assessment and possible treatment of the brachial plexus injury can begin. Major areas of concern to the patient are likely to be management of the pain, which can be chronic and extreme, and which does not generally respond well to many painkillers. Those painkillers which are found to be effective often have serious and debilitating side effects. The patient often has concerns about life after the accident, whether those concerns are related to employment, finances, relationships, self-image or just performing simple tasks with one hand, especially if the dominant arm is injured. Most injured people have concerns in all these areas. There is a period of adjustment to the psychological effects of the damaged limb, which can be very hard on the sufferer and their families. Finding knowledgeable support is a priority in all cases.
CAUSES OF TRAUMA INJURIES
Brachial plexus injuries can happen in many ways. They can be divided into two categories, open or closed injuries. One common cause of a closed injury is a motorcycle accident. It is surmised that following impact, the rider hits the ground, often continues to slide and a brachial plexus injury is caused when the helmeted head is forced away from the point of the shoulder, causing violent traction to the brachial plexus. Closed injuries are usually caused by traction or compression
.ubpn.org United Brachial Plexus Network, Inc. 1.866.877.7004
ADULTS WITH BRACHIAL PLEXUS INJURIES page two
of the brachial plexus, and can be caused by sports injuries, car accidents, falls or radiotherapy, to name a few. Open injuries such as knife wounds or cuts, including surgery, can also cause injury to the brachial plexus.
INJURY CLASSIFICATION AND PROGNOSIS
Brachial plexus injuries need referral to a specialist as soon as possible upon detection. The type and extent of injury is ascertained by clinical evaluation utilizing EMG, seeking out sensory and motor changes in the affected limb, MRI (magnetic resonance imaging) scan and possibly CT Myelogram where contrast dye is injected into the spine and scanned to see if there is leakage from the spine or other indicators of damage. Surgical exploration may be scheduled to physically examine the extent of injury. The types of injury range from mild lesion (stretch) to tears and neuromas (scar tissue that builds up around damaged area) rupture and avulsion (nerve root being pulled from the spine).
Some mild injuries recover quite quickly and spontaneously. Some may benefit from nerve graft surgery (typically at 3 to 6 months post trauma), the donor nerve being taken from the patient’s leg or other possible site and grafted in place of the damaged brachial plexus nerve(s). After nerve surgery the recovery time frame is months to possibly years, although denervated paralyzed/ paralysed muscle tissue will atrophy and may not be receptive to nerve impulses after a period of time. It should be emphasized that just as the many possible complex variations of the injury occur, so does the rate and extent of recovery for each individual patient. As a general rule the smaller fine control muscles in the hand are in the most danger of being lost as the regeneration of damaged nerves is slow, approximately 1 inch or 3 centimeters a month. Therefore, by the time any nerve recovery reaches the patient’s hand, atrophy may have resulted in lost function.
Some injuries unfortunately do not respond to treatment and are so severe that they are permanent. Besides the nerve grafting and scar tissue removal surgeries available as a possible option, there are other surgical techniques which can be utilized long after the initial period of injury. These include muscle and tendon release surgery.
PAIN
Definition
A burner is an injury to the bundle of nerves that runs from the back of your neck into your arm. These separate nerves come together in the upper shoulder to form the brachial plexus. From here, the nerves go to all the arm muscles. A burner is often called a stinger.
Pain can be the most limiting factor in rehabilitation of patients with a brachial plexus injury. It has been observed that pain following avulsions is particularly severe, and has been described, by those affected, variously as crushing, constant burning and even ‘like putting your hand in a deep fat fryer’ or into a vise. An almost unbearable feeling of pressure can build up in the affected limb. However, some people with less severe injuries also report serious pain. In these cases it has been described as being of a different nature to that experienced from avulsions, and is mainly felt when the injury is recovering. It has been reported that 90% of the patients who have avulsions to one or more nerve roots have severe pain.
ADULTS WITH BRACHIAL PLEXUS INJURIES page three
ubpn.org United Brachial Plexus Network, Inc. 1.866.877.7004
Causes
A burner may be caused by:
Stretching of the brachial plexus nerves
This can be caused by your shoulder being pushed down while your head is forced to the other side.
Pinching of the brachial plexus nerves
This can happen if your head is moved quickly to one side.
Bruising of the brachial plexus nerves
This can happen when the area above your collarbone is hit directly.
Risk Factors
A risk factor is something that increases your chance of getting a disease or condition. Risk factors for a burner (stinger) include:
· Playing football – due to receiving direct blows to the head, neck, and shoulders
· Participating in contact sports
Symptoms
Symptoms may include:
· Burning or stinging feeling between your neck and shoulder
· Burning or stinging feeling in one arm
· Numbness, tingling, or weakness in the shoulder or arm
Diagnosis
The doctor will ask about your symptoms and how the injury occurred.
The doctor will examine you for:
· Pain or tenderness
· Neck and arm range of motion
· Strength in the arm and hand
· Arm reflexes
· Sensation in the shoulder and hand
For serious burners you may have an electromyogram (EMG) to verify the diagnosis and determine the extent of the injury.
Treatment
Some burners last only a few minutes and won't require treatment. Others may require physical therapy to strengthen your muscles while you wait for the nerve to heal itself.
Prevention
Keeping the muscles around your neck and shoulders strong and flexible will help you withstand the stress of a direct blow. Avoid using your helmet as a contact point when tackling and blocking in football. Always make sure to wear the proper safety equipment for your sport.
ORGANIZATIONS:
American Orthopaedic Society for Sports Medicine
http://www.aossm.org/
American Academy of Orthopaedic Surgeons
http://www.aaos.org/
SOURCES:
American Academy of Family Physicians
Mayo Foundation for Medical Education and Research
Last reviewed August 2003 by Andrew Wilner, MD
All HealthGate consumer health and medical information found on this site is accredited by URAC. URAC's Health Web Site Accreditation Program requires compliance with 53 rigorous standards of quality and accountability, verified by independent audits.
TREATMENT OF THE PAIN
Management of the pain is difficult. One possibility is electrical stimulation (TNS or TENS) for pain relief. In one study, it was found that of 158 patients, 100 gained significant pain relief as a result of the stimulation. Some of those had experienced pain for a very long time before the stimulation. Some patients report no easing of pain with this method. The ‘pain gate’ theory (the idea that occupation of the patient in tasks etc will ‘block’ the pain impulses in the brain) is often advised, and can be effective. For this reason, if at all possible, it is often best for the patient to return to work or take up another occupation as soon as is practicable. Good results have been reported from use of a chiropractor, massage and other alternatives to drug based analgesia. For extreme cases, surgery of various kinds is sometimes advised. These surgeries include nerve block surgeries, insertion of a pump delivering painkillers direct to the area affected and ablative surgeries, which involve the burning of nerve endings. Surgeries of this kind would normally be undertaken after referral to a specialist pain clinic. Details of these and other methods of dealing with chronic pain may be found from the link to www.pain.com found below under Further Information.It is advisable to discuss your options with a brachial plexus injury specialist and it may be
helpful to discuss the surgery with others who have experienced it.
ANALGESIC DRUGS
Rather than to list effective drugs, especially since different brand names are used internationally, it is simpler to state that, in most cases, opiates are used immediately post trauma, and in some cases continue to be used for some time afterwards. Due to the undesirable side effects of both these and anti-inflammatory drugs, the patient needs to keep pursuing other methods of pain relief, especially if the pain becomes protracted or chronic. Anti-depressants and anti-convulsants have been used, though, again, if long-term use is contemplated, the side effects need to be considered. However, it is a fact that long term or chronic pain often leads to depression and tricyclic anti-depressants are front line treatments for chronic neuropathic pain. Talking with other people who are injured can often help, although all these injuries are different and what works for one might not work for another. Severe pain has been reported as reducing greatly over the years, though pain flare ups still occur many years post trauma, including reports from some patients who have had amputations (phantom limb pain). In most cases, the pain ceases to be a major issue
within the recovery timeframe.
EXERCISE
All patients with brachial plexus injuries will need to undertake exercises to retain the range of motion in the affected limb. This is because unused muscles will atrophy and shrink, which can cause problems later, or prevent functional use of the limb as recovery starts. It is especially important to keep the hand and fingers loose in order that maximum functionality may be restored in the event of any recovery.
ADULTS WITH BRACHIAL PLEXUS INJURIES page four
ubpn.org United Brachial Plexus Network, Inc. 1.866.877.7004
THERAPY
As well as traditional physical therapy there are other treatments known to work well for patients; Hydro or aqua-therapy in a heated pool is an excellent way to loosen and stretch muscles. The heat and hydrostatic pressure of the water offer many benefits. Massage therapy and chiropractic treatment bring relief to many patients. Any muscle motor recovery from previously paralyzed muscle will need strengthening work for a long time after re-innervation. It is important that the patient develops a long-term view of Brachial Plexus injury rehabilitation.
SENSATION/MOVEMENT IN THE AFFECTED ARM
Most brachial plexus injuries result in a completely ‘flail’ arm immediately after the injury happens, with little or no movement detectable. As recovery occurs, the sensation and motor functions of the affected limb may gradually return. Some injuries are less severe and virtually complete recovery may occur in these cases. If sensory function is at all impaired, the patient will need to be extremely careful that the affected limb is not inadvertently damaged. Tables similar to those below are commonly used by doctors to evaluate the level of function in patients.
TABLE ONE: MOTOR FUNCTION
M0 No muscular contraction
M1 Return of perceptible contraction in the proximal muscles
M2 Return of perceptible contraction in both proximal and distal muscles
M3 Return of function in both proximal and distal muscles of such a degree that all
important muscles are able to act against resistance
M4 Return of function as in M3; in addition, all synergic and independent movements
are possible
M5 Complete recovery
TABLE TWO: SENSORY FUNCTION
S0 Absence of sensibility in the autonomous area
S1 Recovery of deep cutaneous pain sensibility within the autonomous area of the nerve
S2 Return of some degree of superficial cutaneous pain and tactile sensibility within the
autonomous area of the nerve
S3 Return of superficial cutaneous pain and tactile sensibility throughout the autonomous
area, with disappearance of any previous over response
S3+ As S3; in addition some recovery of 2 point discrimination within the autonomous area
S4 Complete recovery
ADULTS WITH BRACHIAL PLEXUS INJURIES page five
ubpn.org United Brachial Plexus Network, Inc. 1.866.877.7004
LONG TERM ISSUES FACING ADULTS WITH BRACHIAL PLEXUS INJURIES
Because the unaffected arm has done double duty for so many years, it ages more quickly and is prone to stress-related injuries, such as tendonitis, bursitis, carpal tunnel syndrome and muscle injury. Arthritis is reported in both the affected and unaffected arms and shoulders. It is imperative for an adult with such an injury to be aware of this and not to overuse either the affected or unaffected arm. They may need to learn to ask for help whenever possible in order to avoid such injuries.
PSYCHOLOGICAL ISSUES
It is important to understand that even in its mildest forms, a brachial plexus injury is truly life changing. Many people with these injuries have periods of depression and while this could be considered a normal reaction to any traumatic event, the ongoing nature of the injury may cause the depression to become serious or prolonged. In addition, worries about self-image, relatio nships and finances are likely to be causing extra anxiety. The patient will need to learn to share his or her problems with frie nds or family, and seek medical help where necessary. The depression can be more limiting than the injury, it is important to realize it will pass and seek help where ne cessary. As time passes and the patient gains acceptance and becomes accustomed to the life changes wrought by the injury, such periods of depression become fewer.
FURTHER INFORMATION
ubpn.org
Contains information, lively message boards and support from brachial plexus injured people and their carers worldwide.
www.nabd.org.uk
Directed at injured motorcyclists, with help and advice re: getting back on the road. Excellent personal profiles and stories, good general and specific information.
www.independentliving.org
A site dedicated to the support of all disabled people, with links to many helpful sites and resources to help with all aspects of disability, from the psychological to human rights.
www.pain.com
As its name suggests, this site is of interest to those suffering from chronic pain. Details of surgeries etc, including case studies. There is an extensive library of articles written.
The appearance of information in the UBPN, Inc. Awareness materials does not constitute nor imply endorsement by UBPN, Inc., its
Board of Directors or members of the Awareness Committee. Individuals must consult with trusted clinicians to determine the appropriateness
of products or services for their specific needs.
ubpn.org United Brachial Plexus Network, Inc. 1.866.877.7004
ADULTS WITH BRACHIAL PLEXUS INJURIES page six
Brachial Plexus Injuries
Brachial plexus injuries are injuries affecting the network of nerves that control the muscles of the shoulder, arm, elbow, wrist, hand and fingers. Brachial plexus injuries can result in full to partial paralysis of one or both (bilateral) arms. Stretching,
tearing or other trauma can cause injury to the nerves of the brachial plexus. Brachial plexus injuries often occur during the birthing process, and can also occur as a result of automobile, motorcycle, or boating accidents; sports injuries (“burners” and “stingers”); animal bites, gunshot or puncture wound; as a result of specific medical treatments/procedures/ surgeries; or due to viral causes. Brachial plexus injuries sustained during the birthing process are known as Obstetrical Brachial Plexus Injuries (OBPI), and those caused by other types of trauma are known as Traumatic Brachial Plexus Injuries (TBPI). Both types are also sometimes referred to as Erb’s Palsy, Klumpke’s Palsy or
Brachial Plexus Palsy. Traumatic brachial plexus injuries can be divided into two categories: open and closed. Closed injuries are those that occur due to excessive traction
(motorcycle accidents and sports injuries); and open injuries are those that occur without excessive traction (gunshot wounds and animal bites). The mildest form of brachial plexus injury occurs when the nerves have been stretched. When the nerves have been torn (ruptured) or pulled out of their spinal “socket” (avulsed), surgical intervention
may be the only hope for regaining functional use of the arm.
Steps to Recovery
A person who is newly injured should visit a brachial plexus specialist as soon as possible. The extent of the injury is sometimes ascertained by clinical evaluation and/or through the use of tests that may include: EMG, MRI & CT scans, and CT
Myelogram. Surgical exploration may be scheduled to physically examine the extent and nature of the injury. The neurosurgical techniques most often used to repair a severe injury are: exploration of the brachial plexus nerves, testing the nerves to see if the
brain is receiving messages from them (EMG), removal of the scar tissue that has formed around the nerve (neuroma), and if necessary, nerve grafting. This first surgery, or "primary surgery,” is usually done 3 to 6 months post-trauma. Donor nerves are usually taken from the legs (sural nerves).
Time is of the Essence
The timeframe for surgical repair is one of the most important factors impacting recovery. When a nerve is injured, it regresses back to its origin in the spinal column in the neck. Regeneration occurs at a slow rate of one inch or 3 centimeters per month and the nerves have to grow down the entire length of the arm. The problem experienced is that within 12 months of the injury, the muscles that have not already been innervated (connected to nerves) will have atrophied to the point where innervation is no longer possible. The smaller fine control muscles in the hand are in the most danger of being lost—because they are the furthest away from the origin of the nerves.
Loss of Sensation
Most brachial plexus injuries result in a completely “flail” arm immediately after the injury happens, with little or no movement detectable. As recovery occurs, the sensation and motor functions of the affected limb may gradually return. Some injuries
are less severe and virtually complete recovery may occur in these cases. If sensory function is at all impaired, the patient will need to be extremely careful that the affected limb is not inadvertently damaged.
Treatment of Pain
Pain can be one of the most limiting factors in rehabilitation for those with brachial plexus injuries. The pain has been described as being very severe: “like a crushing feeling,” “like putting your hand in a deep fat fryer,” “a constant burning,” or “like lightening bolts.” Also reported is a feeling of constant pressure. Treatment of pain can include the use of analgesics, anti-depressants, anti-convulsives, electrical stimulation (TENS) and specific pain-reducing surgical treatments which include nerve blocks, insertion of a pump to deliver pain medication directly to the area involved, and ablation techniques that literally burn the nerve endings. Alternative medicine including acupuncture, chiropractic and massage therapy have been reported to be helpful.
The “pain gate theory” – the theory that occupation of the patient in tasks will “block” the pain impulses in the brain – is often advised and can be effective.
Therapy and Exercise
People with brachial plexus injuries must develop a long-term view of brachial plexus injury rehabilitation. Establishing a relationship with a physical and/or occupational therapist will be necessary and helpful. Splinting of the affected side can offer support and be valuable for rehabilitation. The therapist will be able to define what splint will be most effective for the different problems encountered. Range of motion exercises (ROM) will help keep the joints loose so that maximum functionality may be restored in the event of recovery. Aquatic therapy in a heated pool is an excellent way to loosen and
Other Information
Traumatic Brachial Plexus Speedy35 Posted: Sep 24, 2004 6:34 PM Reply
Hi! I am new to this site with the forum but not new with the Hospital, my son was born with brachial plexus, and from listening to all the Doctors here in Pennsylvania my sons arm can no longer be fixed, but since my brother was in a very bad accident. He was cutting down a tree and unfortunatly it fell and hit him on the right side. He had a broken back, broken neck, and many more injuries along with Brachial Plexus to the right arm, his median and ulna of the lower trunk have came back some but the radial and upper trunk haven't came back any. He has no movement in the elbow or bicep and his shoulder, they are giving him another month before doing a nerve transfer, what if any is the out come of such surgery and aren't they wasting time? Please Help as I don't want my brother to end up Helpless like my son?
Having coped well through their childhood and young adulthood with the injury, some adults as they age may start to experience long term problems in their affected arm and overuse symptoms in their unaffected arm. Family doctors in many cases do not realize that these problems may be specifically related to the brachial plexus injury. It may be extremely beneficial for these adults affected by brachial plexus injuries to seek help from a specialist even in later life. In addition, the many years of existing with the injury make these adults a valuable information resource in themselves, especially for parents of newly injured babies and also for adults who have suffered a traumatic brachial plexus injury. Finding a support group can therefore be extremely helpful. Just finding that there are many others facing similar challenges can be very comforting for those who have suffered alone for so long.
I Richard Khamani have sent this to you on sht notice ,giv me a little time, but contact me at jerryjkd@yahoo.com to remind me.
Good Luck
Injured associate.....
TRAUMATIC BRACHIAL PLEXUS INJURIES
Brachial plexus injuries caused by road accident or other physical trauma are known as trau-
matic brachial plexus injuries (TBPI). These are devastating injuries that sometimes do not recover spontaneously or respond well to treatment. For this reason, expert specialist help should be sought as soon as possible after diagnosis. As the causes of such injuries are often violent, such as road accidents, gunshot or knife wounds, establishing and treating other, possibly life threatening injuries incurred at the same time is often the priority immediately post trauma. Sometimes there can be a delay in the detection and treatment of the brachial plexus injury because treatment of these other, more immediately serious injuries has to take priority. Once any more dangerous conditions have been identified and stabilized, the assessment and possible treatment of the brachial plexus injury can begin. Major areas of concern to the patient are likely to be management of the pain, which can be chronic and extreme, and which does not generally respond well to many painkillers. Those painkillers which are found to be effective often have serious and debilitating side effects. The patient often has concerns about life after the accident, whether those concerns are related to employment, finances, relationships, self-image or just performing simple tasks with one hand, especially if the dominant arm is injured. Most injured people have concerns in all these areas. There is a period of adjustment to the psychological effects of the damaged limb, which can be very hard on the sufferer and their families. Finding knowledgeable support is a priority in all cases.
CAUSES OF TRAUMA INJURIES
Brachial plexus injuries can happen in many ways. They can be divided into two categories, open or closed injuries. One common cause of a closed injury is a motorcycle accident. It is surmised that following impact, the rider hits the ground, often continues to slide and a brachial plexus injury is caused when the helmeted head is forced away from the point of the shoulder, causing violent traction to the brachial plexus. Closed injuries are usually caused by traction or compression
.ubpn.org United Brachial Plexus Network, Inc. 1.866.877.7004
ADULTS WITH BRACHIAL PLEXUS INJURIES page two
of the brachial plexus, and can be caused by sports injuries, car accidents, falls or radiotherapy, to name a few. Open injuries such as knife wounds or cuts, including surgery, can also cause injury to the brachial plexus.
INJURY CLASSIFICATION AND PROGNOSIS
Brachial plexus injuries need referral to a specialist as soon as possible upon detection. The type and extent of injury is ascertained by clinical evaluation utilizing EMG, seeking out sensory and motor changes in the affected limb, MRI (magnetic resonance imaging) scan and possibly CT Myelogram where contrast dye is injected into the spine and scanned to see if there is leakage from the spine or other indicators of damage. Surgical exploration may be scheduled to physically examine the extent of injury. The types of injury range from mild lesion (stretch) to tears and neuromas (scar tissue that builds up around damaged area) rupture and avulsion (nerve root being pulled from the spine).
Some mild injuries recover quite quickly and spontaneously. Some may benefit from nerve graft surgery (typically at 3 to 6 months post trauma), the donor nerve being taken from the patient’s leg or other possible site and grafted in place of the damaged brachial plexus nerve(s). After nerve surgery the recovery time frame is months to possibly years, although denervated paralyzed/ paralysed muscle tissue will atrophy and may not be receptive to nerve impulses after a period of time. It should be emphasized that just as the many possible complex variations of the injury occur, so does the rate and extent of recovery for each individual patient. As a general rule the smaller fine control muscles in the hand are in the most danger of being lost as the regeneration of damaged nerves is slow, approximately 1 inch or 3 centimeters a month. Therefore, by the time any nerve recovery reaches the patient’s hand, atrophy may have resulted in lost function.
Some injuries unfortunately do not respond to treatment and are so severe that they are permanent. Besides the nerve grafting and scar tissue removal surgeries available as a possible option, there are other surgical techniques which can be utilized long after the initial period of injury. These include muscle and tendon release surgery.
PAIN
Definition
A burner is an injury to the bundle of nerves that runs from the back of your neck into your arm. These separate nerves come together in the upper shoulder to form the brachial plexus. From here, the nerves go to all the arm muscles. A burner is often called a stinger.
Pain can be the most limiting factor in rehabilitation of patients with a brachial plexus injury. It has been observed that pain following avulsions is particularly severe, and has been described, by those affected, variously as crushing, constant burning and even ‘like putting your hand in a deep fat fryer’ or into a vise. An almost unbearable feeling of pressure can build up in the affected limb. However, some people with less severe injuries also report serious pain. In these cases it has been described as being of a different nature to that experienced from avulsions, and is mainly felt when the injury is recovering. It has been reported that 90% of the patients who have avulsions to one or more nerve roots have severe pain.
ADULTS WITH BRACHIAL PLEXUS INJURIES page three
ubpn.org United Brachial Plexus Network, Inc. 1.866.877.7004
Causes
A burner may be caused by:
Stretching of the brachial plexus nerves
This can be caused by your shoulder being pushed down while your head is forced to the other side.
Pinching of the brachial plexus nerves
This can happen if your head is moved quickly to one side.
Bruising of the brachial plexus nerves
This can happen when the area above your collarbone is hit directly.
Risk Factors
A risk factor is something that increases your chance of getting a disease or condition. Risk factors for a burner (stinger) include:
· Playing football – due to receiving direct blows to the head, neck, and shoulders
· Participating in contact sports
Symptoms
Symptoms may include:
· Burning or stinging feeling between your neck and shoulder
· Burning or stinging feeling in one arm
· Numbness, tingling, or weakness in the shoulder or arm
Diagnosis
The doctor will ask about your symptoms and how the injury occurred.
The doctor will examine you for:
· Pain or tenderness
· Neck and arm range of motion
· Strength in the arm and hand
· Arm reflexes
· Sensation in the shoulder and hand
For serious burners you may have an electromyogram (EMG) to verify the diagnosis and determine the extent of the injury.
Treatment
Some burners last only a few minutes and won't require treatment. Others may require physical therapy to strengthen your muscles while you wait for the nerve to heal itself.
Prevention
Keeping the muscles around your neck and shoulders strong and flexible will help you withstand the stress of a direct blow. Avoid using your helmet as a contact point when tackling and blocking in football. Always make sure to wear the proper safety equipment for your sport.
ORGANIZATIONS:
American Orthopaedic Society for Sports Medicine
http://www.aossm.org/
American Academy of Orthopaedic Surgeons
http://www.aaos.org/
SOURCES:
American Academy of Family Physicians
Mayo Foundation for Medical Education and Research
Last reviewed August 2003 by Andrew Wilner, MD
All HealthGate consumer health and medical information found on this site is accredited by URAC. URAC's Health Web Site Accreditation Program requires compliance with 53 rigorous standards of quality and accountability, verified by independent audits.
TREATMENT OF THE PAIN
Management of the pain is difficult. One possibility is electrical stimulation (TNS or TENS) for pain relief. In one study, it was found that of 158 patients, 100 gained significant pain relief as a result of the stimulation. Some of those had experienced pain for a very long time before the stimulation. Some patients report no easing of pain with this method. The ‘pain gate’ theory (the idea that occupation of the patient in tasks etc will ‘block’ the pain impulses in the brain) is often advised, and can be effective. For this reason, if at all possible, it is often best for the patient to return to work or take up another occupation as soon as is practicable. Good results have been reported from use of a chiropractor, massage and other alternatives to drug based analgesia. For extreme cases, surgery of various kinds is sometimes advised. These surgeries include nerve block surgeries, insertion of a pump delivering painkillers direct to the area affected and ablative surgeries, which involve the burning of nerve endings. Surgeries of this kind would normally be undertaken after referral to a specialist pain clinic. Details of these and other methods of dealing with chronic pain may be found from the link to www.pain.com found below under Further Information.It is advisable to discuss your options with a brachial plexus injury specialist and it may be
helpful to discuss the surgery with others who have experienced it.
ANALGESIC DRUGS
Rather than to list effective drugs, especially since different brand names are used internationally, it is simpler to state that, in most cases, opiates are used immediately post trauma, and in some cases continue to be used for some time afterwards. Due to the undesirable side effects of both these and anti-inflammatory drugs, the patient needs to keep pursuing other methods of pain relief, especially if the pain becomes protracted or chronic. Anti-depressants and anti-convulsants have been used, though, again, if long-term use is contemplated, the side effects need to be considered. However, it is a fact that long term or chronic pain often leads to depression and tricyclic anti-depressants are front line treatments for chronic neuropathic pain. Talking with other people who are injured can often help, although all these injuries are different and what works for one might not work for another. Severe pain has been reported as reducing greatly over the years, though pain flare ups still occur many years post trauma, including reports from some patients who have had amputations (phantom limb pain). In most cases, the pain ceases to be a major issue
within the recovery timeframe.
EXERCISE
All patients with brachial plexus injuries will need to undertake exercises to retain the range of motion in the affected limb. This is because unused muscles will atrophy and shrink, which can cause problems later, or prevent functional use of the limb as recovery starts. It is especially important to keep the hand and fingers loose in order that maximum functionality may be restored in the event of any recovery.
ADULTS WITH BRACHIAL PLEXUS INJURIES page four
ubpn.org United Brachial Plexus Network, Inc. 1.866.877.7004
THERAPY
As well as traditional physical therapy there are other treatments known to work well for patients; Hydro or aqua-therapy in a heated pool is an excellent way to loosen and stretch muscles. The heat and hydrostatic pressure of the water offer many benefits. Massage therapy and chiropractic treatment bring relief to many patients. Any muscle motor recovery from previously paralyzed muscle will need strengthening work for a long time after re-innervation. It is important that the patient develops a long-term view of Brachial Plexus injury rehabilitation.
SENSATION/MOVEMENT IN THE AFFECTED ARM
Most brachial plexus injuries result in a completely ‘flail’ arm immediately after the injury happens, with little or no movement detectable. As recovery occurs, the sensation and motor functions of the affected limb may gradually return. Some injuries are less severe and virtually complete recovery may occur in these cases. If sensory function is at all impaired, the patient will need to be extremely careful that the affected limb is not inadvertently damaged. Tables similar to those below are commonly used by doctors to evaluate the level of function in patients.
TABLE ONE: MOTOR FUNCTION
M0 No muscular contraction
M1 Return of perceptible contraction in the proximal muscles
M2 Return of perceptible contraction in both proximal and distal muscles
M3 Return of function in both proximal and distal muscles of such a degree that all
important muscles are able to act against resistance
M4 Return of function as in M3; in addition, all synergic and independent movements
are possible
M5 Complete recovery
TABLE TWO: SENSORY FUNCTION
S0 Absence of sensibility in the autonomous area
S1 Recovery of deep cutaneous pain sensibility within the autonomous area of the nerve
S2 Return of some degree of superficial cutaneous pain and tactile sensibility within the
autonomous area of the nerve
S3 Return of superficial cutaneous pain and tactile sensibility throughout the autonomous
area, with disappearance of any previous over response
S3+ As S3; in addition some recovery of 2 point discrimination within the autonomous area
S4 Complete recovery
ADULTS WITH BRACHIAL PLEXUS INJURIES page five
ubpn.org United Brachial Plexus Network, Inc. 1.866.877.7004
LONG TERM ISSUES FACING ADULTS WITH BRACHIAL PLEXUS INJURIES
Because the unaffected arm has done double duty for so many years, it ages more quickly and is prone to stress-related injuries, such as tendonitis, bursitis, carpal tunnel syndrome and muscle injury. Arthritis is reported in both the affected and unaffected arms and shoulders. It is imperative for an adult with such an injury to be aware of this and not to overuse either the affected or unaffected arm. They may need to learn to ask for help whenever possible in order to avoid such injuries.
PSYCHOLOGICAL ISSUES
It is important to understand that even in its mildest forms, a brachial plexus injury is truly life changing. Many people with these injuries have periods of depression and while this could be considered a normal reaction to any traumatic event, the ongoing nature of the injury may cause the depression to become serious or prolonged. In addition, worries about self-image, relatio nships and finances are likely to be causing extra anxiety. The patient will need to learn to share his or her problems with frie nds or family, and seek medical help where necessary. The depression can be more limiting than the injury, it is important to realize it will pass and seek help where ne cessary. As time passes and the patient gains acceptance and becomes accustomed to the life changes wrought by the injury, such periods of depression become fewer.
FURTHER INFORMATION
ubpn.org
Contains information, lively message boards and support from brachial plexus injured people and their carers worldwide.
www.nabd.org.uk
Directed at injured motorcyclists, with help and advice re: getting back on the road. Excellent personal profiles and stories, good general and specific information.
www.independentliving.org
A site dedicated to the support of all disabled people, with links to many helpful sites and resources to help with all aspects of disability, from the psychological to human rights.
www.pain.com
As its name suggests, this site is of interest to those suffering from chronic pain. Details of surgeries etc, including case studies. There is an extensive library of articles written.
The appearance of information in the UBPN, Inc. Awareness materials does not constitute nor imply endorsement by UBPN, Inc., its
Board of Directors or members of the Awareness Committee. Individuals must consult with trusted clinicians to determine the appropriateness
of products or services for their specific needs.
ubpn.org United Brachial Plexus Network, Inc. 1.866.877.7004
ADULTS WITH BRACHIAL PLEXUS INJURIES page six
Brachial Plexus Injuries
Brachial plexus injuries are injuries affecting the network of nerves that control the muscles of the shoulder, arm, elbow, wrist, hand and fingers. Brachial plexus injuries can result in full to partial paralysis of one or both (bilateral) arms. Stretching,
tearing or other trauma can cause injury to the nerves of the brachial plexus. Brachial plexus injuries often occur during the birthing process, and can also occur as a result of automobile, motorcycle, or boating accidents; sports injuries (“burners” and “stingers”); animal bites, gunshot or puncture wound; as a result of specific medical treatments/procedures/ surgeries; or due to viral causes. Brachial plexus injuries sustained during the birthing process are known as Obstetrical Brachial Plexus Injuries (OBPI), and those caused by other types of trauma are known as Traumatic Brachial Plexus Injuries (TBPI). Both types are also sometimes referred to as Erb’s Palsy, Klumpke’s Palsy or
Brachial Plexus Palsy. Traumatic brachial plexus injuries can be divided into two categories: open and closed. Closed injuries are those that occur due to excessive traction
(motorcycle accidents and sports injuries); and open injuries are those that occur without excessive traction (gunshot wounds and animal bites). The mildest form of brachial plexus injury occurs when the nerves have been stretched. When the nerves have been torn (ruptured) or pulled out of their spinal “socket” (avulsed), surgical intervention
may be the only hope for regaining functional use of the arm.
Steps to Recovery
A person who is newly injured should visit a brachial plexus specialist as soon as possible. The extent of the injury is sometimes ascertained by clinical evaluation and/or through the use of tests that may include: EMG, MRI & CT scans, and CT
Myelogram. Surgical exploration may be scheduled to physically examine the extent and nature of the injury. The neurosurgical techniques most often used to repair a severe injury are: exploration of the brachial plexus nerves, testing the nerves to see if the
brain is receiving messages from them (EMG), removal of the scar tissue that has formed around the nerve (neuroma), and if necessary, nerve grafting. This first surgery, or "primary surgery,” is usually done 3 to 6 months post-trauma. Donor nerves are usually taken from the legs (sural nerves).
Time is of the Essence
The timeframe for surgical repair is one of the most important factors impacting recovery. When a nerve is injured, it regresses back to its origin in the spinal column in the neck. Regeneration occurs at a slow rate of one inch or 3 centimeters per month and the nerves have to grow down the entire length of the arm. The problem experienced is that within 12 months of the injury, the muscles that have not already been innervated (connected to nerves) will have atrophied to the point where innervation is no longer possible. The smaller fine control muscles in the hand are in the most danger of being lost—because they are the furthest away from the origin of the nerves.
Loss of Sensation
Most brachial plexus injuries result in a completely “flail” arm immediately after the injury happens, with little or no movement detectable. As recovery occurs, the sensation and motor functions of the affected limb may gradually return. Some injuries
are less severe and virtually complete recovery may occur in these cases. If sensory function is at all impaired, the patient will need to be extremely careful that the affected limb is not inadvertently damaged.
Treatment of Pain
Pain can be one of the most limiting factors in rehabilitation for those with brachial plexus injuries. The pain has been described as being very severe: “like a crushing feeling,” “like putting your hand in a deep fat fryer,” “a constant burning,” or “like lightening bolts.” Also reported is a feeling of constant pressure. Treatment of pain can include the use of analgesics, anti-depressants, anti-convulsives, electrical stimulation (TENS) and specific pain-reducing surgical treatments which include nerve blocks, insertion of a pump to deliver pain medication directly to the area involved, and ablation techniques that literally burn the nerve endings. Alternative medicine including acupuncture, chiropractic and massage therapy have been reported to be helpful.
The “pain gate theory” – the theory that occupation of the patient in tasks will “block” the pain impulses in the brain – is often advised and can be effective.
Therapy and Exercise
People with brachial plexus injuries must develop a long-term view of brachial plexus injury rehabilitation. Establishing a relationship with a physical and/or occupational therapist will be necessary and helpful. Splinting of the affected side can offer support and be valuable for rehabilitation. The therapist will be able to define what splint will be most effective for the different problems encountered. Range of motion exercises (ROM) will help keep the joints loose so that maximum functionality may be restored in the event of recovery. Aquatic therapy in a heated pool is an excellent way to loosen and
Other Information
Traumatic Brachial Plexus Speedy35 Posted: Sep 24, 2004 6:34 PM Reply
Hi! I am new to this site with the forum but not new with the Hospital, my son was born with brachial plexus, and from listening to all the Doctors here in Pennsylvania my sons arm can no longer be fixed, but since my brother was in a very bad accident. He was cutting down a tree and unfortunatly it fell and hit him on the right side. He had a broken back, broken neck, and many more injuries along with Brachial Plexus to the right arm, his median and ulna of the lower trunk have came back some but the radial and upper trunk haven't came back any. He has no movement in the elbow or bicep and his shoulder, they are giving him another month before doing a nerve transfer, what if any is the out come of such surgery and aren't they wasting time? Please Help as I don't want my brother to end up Helpless like my son?
-
admin
- Site Admin
- Posts: 19873
- Joined: Mon Nov 16, 2009 9:59 pm
Re: Curious as to where u get the pain
James is 11 and TBPI. He tells me that he gets BAD pain in his fingers and hand. I asked him what does it feel like and he says like he has his hand on the stove burner. He has accidently stuck his hand on the stove before so he knows what its like. He just grabs his hand in panic and bounces around like hes gone crazy but it doesnt usually last long. I agree with Karl, I think it helps if I can immediately focus James on something else on his opposite side. He has some pain in his arm but more in his shoulder and back. We do some massage therapy, just gently caressing his shoulder and back and neck area. It seems to really relax him alot.