United Brachial Plexus Network, Inc.

Wanted to say hi, tell my story and see if anyone can offer some advice. I was in a motorcycle accident back in August and droke my right clavicle and stretched BP (I think). At the time of the accident i had total paralysis of the right arm not including the fingers. Since then I have gotten some movement back, for example; strong pronation of the forarm but very week supination, very week elbow flexion and extension, very little feeling in deltoid and supersinatis and the EMG showed total nerve block to both plus the outer head of the bicep. The orthopedics doctor has told me I have injury to the c-5 nerve near the root however it was not avulsed. Any one have/had a injury similar to mine? The medical staff is having me play the waiting game for surgical intervintion, which i am fine with, I would prefer not to have surgery. Any one have any luck with alternative medicine,accupunture,message,herbs/vitamens,TENS units,changes in diet ect? Also I want to start working out again. Anyone run with there arm in a sling? Was thinking i could swim side stroke with my effected arm holding my waist band or use the kick board. Any suggestions would be greatly appritiated.

First of all welcome to the boards!! Sounds like Dustin had a little more damage than you. His was c5-7 with no avulsions. But like you he does have hand. The rest started out completely paralized. Now one year post accident he can move the arm all over when out of gravity (on his side or in water). We continue to see more strength. He can use weights when on his side. But remember that nerves heal at about 1 inch per month. So yes it is a long slow process. You should be seeing a therapist to set you up with exercises to help improve things. I would think swimming would be great. You should try to strengthen the arm when in water. I know others run but due to Dustins other injuries running isn't possible at this time. He did use an EMS and now uses an EMPI. Yes they did help. Good luck!
Sue

Sounds a lot like our son's. Eric flew off his bicycle at 70 km/hr on August 10. Broken clavicle has healed fine. Definitely c5,total paralysis according to EMGs and NS. We can see total loss of muscle mass in shoulder muscles - deltoid, spinati,and some loss of arm musculature. He has no arm movement at all, wrist and hand only. NS has him scheduled for reconstructive surgery here Dec.12. We are off to the Mayo clinic Nov.27 for a 2nd opinion. BTW our NS told us that MRI's are only about 80 percent reliable for diagnosing avulsions, so he will definitely start cutting right at the spine to check for that.

Sounds like you have some forearm movement. Can you move the arm as a whole back and forth or up and away from your body? Even a bit?

The docs all prefer not to operate if there's a chance of natural healing; that said, there is a limited window to repair nerves to their optimum recovery.I suspect your docs know that, and have seen enough improvement to want to wait and watch. No doubt they will do another set of EMG's in a month or two to monitor your progress.

I hope you are doing physiotherapy to keep your muscles strong. We have been told that TENS does not appear to retain any strength in a muscle that is not receiving any signals from the nerves. For recovering muscles, though, it is supposed to be a good therapy.

Thamks for the responsis. I do have forarm movment as said above I can ponate (rotate hand downward) and supinate (rotate hand upward) very week and not all the way. I can also bend my arm at the eldow however it takes everything i got and can barly get it to my waist (I think im using nothing but brachialis). If my arm is out to the side fully extended (laying down) I can bring it to my side. I can extend my arm outward but its difficult,when I try and move my arm it aucomatically comes to my body I cant hold it out meaning i cant bring it straight up even laying down it will flop tward or away from my body. I can push and pull for instance with my hand on a ball or dowle I can roll it both ways (forwad and back) untill my hand falls off to either side. My hand and wrist flexion is strong, I can write with it as long as I position my arm first and move it as I go with the other hand. Physical Theropy is all I am doing and its limited to the range of motion stuff, I do everyday somtimes two or three times a day.I want to do more for rest of my body so I dont get out of shape. I also have a TENS unit but it seems the muscles that are not working wont even twitch no matter how high its on is why I asked. I have to go for now I will describe my doc visits in more detail later hopfully people will give me som advice on what to ask neurologist when I see him this week (hopefully) again thanks u 2 for your responses.

Hi, just to clarify...

TENS is NOT used for increasing muscle strength, it is for the use of pain management in muscles. NMES is used for strength increase. Is that what you mean? If not, that is why the TENS is not working!
Marieke (31, LOBPI)
http://nurse-to-be08.blogspot.com/

This is the unit i have http://www.rsmedical.com/product_rs4i.asp

Nice machine, I see it does both at the same time... how high/what frequencies are programmed?
I have a machine that does both too... but I usually do only the NMES by itself.
this is mine: http://www.mylontech.com/elpha3000.asp
Marieke

I am not sure of the frequency, it come preset. I cant even skip portions of it for instance it has two modes, one for pain and one for muscle stimulation. I cant skip the pain mode.

I have been doing lots of reading on this. Basically everything I can get my hands on. I have only seen the neurologist one time since my injury happened in August and that was late September. I read that successful repair of avulsed or ruptured nerves depends greatly on timely intervention. My question is how long should elapse before the neurologist should surgically explore.

I believe i see the neurologist again tomorrow but I'm not for sure I have to call in the morning to verify, any recommendations on questions I should ask.

On muscle stim. hardware (OoPs on the TENS), you won't get a response if the nerve is still badly damaged.

I have read/been told by various medical and non-medical folk that the repair window is somewhere between four and six or eight months for optimal recovery. You are somewhere between two and three months.

I should think what you want to know is if you have made progress since your previous visit to the neurologist. Hopefully you had EMG's and he will be scheduling new ones. If he says there has been little or no change in any specific muscle, he should be starting to talk surgery, which means a referral to a neurosurgeon or other BP specialist. If referrals take a while, I would ask to get moving on it, even if he's not yet sure whether surgery is necessary. We saw the NS first at 6 weeks.

However, it sounds like you are doing reasonably well and perhaps won't need surgery. If the neurologist doesn't think so, ask when he will see you next and make sure it's within the 6 months since your accident.

As for strength training, I guess you can ask the neurologist about that too. Eric has not done any as there is no signal.

Yes, when Dustin hit the 6 mo post accident mark they went in to make sure nothing was avulsed as they feel that is the outer limits of time for nerve graphs. We went to Mayo and saw Drs Spinner, Chin and Bishop. At first they thought about waiting as there was some improvement. But when they discussed timing they did not want to miss the window of opportunity. They went in and nothing was avulsed but did remove scar tissue. And the EMG they did when they had it open showed impulses in all nerves, some weaker than others. Dustin has done ROM and exercises since he was able after the accident. He has seen an OT for the arm all this time.
Sue