United Brachial Plexus Network, Inc.

This may be a very stupid question, I apologize in advance. I have a child with obpi and have been reading the boards for over a year now. I read all of the forums and it seems that tbpi is more devastating than obpi. My question is why? Is it because of the age of the individual and the way that nerves regenerate/reinerverate? I had never heard of bpi's until this happened to my child. When I started reading this board I learned about tbpi's. While they both seem so tragic, it seems that there aren't as many options out there for those who suffer from tbpi. Am I right?

Guest, This is not a stupid question at all! I have wondered about it too, and Im glad you posted this. I have a 12 year old child with a TBPI. Ive had the same questions as you. I guess the only people that could answer this would be the adults who have had it from birth, like Nancy, etc.. and the adults who are traumatically injured. From what Ive read, the surgery options are the same for both? depending on the injury type and what surgery needs to be done, but I THINK age plays a big roll in how well they heal? The younger TBPI's seems to have a better chance at recovery since their still growing that the adults. Someone please tell me if Im wrong? No offense taken, honestly, Id like to know too.

I wouldnt say that TBPI is more devastating but but the recovery rate is no wheres near as good dor us as it is for OBPI. i Have met a few blokes who have gotten great functional return with theirsbut I have also met a few who have amputated because the damage was bad, no functional return, and the arm was just in the way.

With most TBPI we are older so our bodies are done growing. With the nerves renenerating at such a slow rate, it take a long time for the neres to reach out fingers. Sometimes it takes too long. If the muscles arent inervated soon, the become atrophed and are no good! We also have a shorter window of recovery time with surgery and such, with not such a great out come because of the above.

I would have to add that is can be extremely hard going from use of two "good arms" to only one...... with OBPI that is all they know.

There are many options out there for TBPI and more are coming everyday but it is hard to find these places right away. Also for many of us there were more serious injuries at the time we got BP'd so the BPI wasnt the main priority.

hope this helps you.......

COurt xx

Thanks Courtney and Rich, your posts did help put some things in perspective. I really didn't want to offend anyone who has a tbpi by the post (and I hope I didn't), I've just been thinking more about tbpi's lately and the options that are available.
Thanks again!

It's as you say, the tbpi injuries are usually sustained in high impact accidents with multiple avulsions. As a percentage there would probably be more severe bpi in any tbpi population. Mild injuries heal pretty quickly, most of those posting regularly here don't have mild injuries.

It may not be not true to say tbpi heal more slowly than obpi though, check this long term study http://brain.oupjournals.org/cgi/content/full/125/1/113 it is primarily about why obpi don't have the same pain as many tbpi but does go into the differing healing processes. The doctor speculates a to why this might be but whatever the reason I found this fascinating.
I can only speak for myself, but I would consider that despite the global nature of my injury, it has had a relatively minimal impact on my life so far. I have spoken to others with much less severe bpi injuries who appear really profoundly affected. How badly someone's life is affected by bpi is much more about how they feel than how well the injury recovers. I feel great! Wearing glasses has definitely affected me much more, and I would be totally disabled without them, whereas I manage just fine without my right arm...... :0)
Happy healing everyone
Jen NZ

Hi,
I wonder if it has anything to do with the fact that a babys body is only so new and it doesn't remember how things should be, therefore making the pain less.
I have a left tbpi and my right arm and shoulder got pulled off. This is certainly the case with phantom pain from a lost arm. They say the younger you arm the better chance of the pain fading over time. If it happened to an infant their body doesn't have the memory of the arm so set.
I don't really know if this could be the same with bpi but maybe??
I have often wondered about your exact question, and just hoped to hell it wasn't this bad for little babys.

I didnt say very well what I meant, sorry. I didnt mean to say young ones have a better chance of healing but maybe they heal faster because the nerves dont have so far to heal than adults. Ok, LOL! Ill shut up.

Just would like to add a bit on this..the incidence of moderate to severe pain accompanying an adult TBPI is probably around 92% when first injured, but this generally subsides to tolerable levels, or even goes away completely for much of the time after about 2-3 years after injury.

Injuries that have pre-ganglionic avulsions seem to produce the most pain and this is probably due to the fact that the spinal cord is also probably microscopically damaged.

No one really knows why pain appears to be worse with a TBP, but there are several theories. One of them is the fact that as an adult, you have experienced certain kinds of pain and the brain remembers this for future protection of the body (burns for instance) Also that you have experienced enough of life to know what would cause you pain (hitting yourself with a hammer)A very small child wouldn't know this before doing it, but then the body reflexes would step in and the child would be rescued from any real harm (hopefully!) by the pain mechanism itself.

I'm really pleased that Dr Waters is conducting this research. It seems daft to me that Drs would ever think that babies feel no pain. Apparently, and horrifyingly they did think this and in the past performed surgery on these poor kids without anaethesia. Doesn't bear thinking about. :0(

Lizzy B