United Brachial Plexus Network, Inc.

Hello all...

I've been lurking the forum for some time. I finally decided to post and would be very happy if you shared your opinions.

I'm from Istanbul. Male, 27 years old. And here is a long summary of my brief story, please bear with me:

Early June 2007; on a nice clear Sunday, around noon, I was on my way to a granny visit on my beloved bike. While cruising around 80 km/h on a freeway I got rammed from the back by a car, got squashed between the car and the barrier to my left. I supposedly flew off over the barrier towards the incoming lane. Can't remember, but it was evident from the damage and the accident reports of the police. I probably crashed into the incoming lane's side barriers and passed out.

Had all the crash equipment. Still; my spleen was ruptured to the 4th grade. My left humerus suffered a complicated open fracture. I also lost a substantial amount of blood due to these injuries. They first hospitalized me for my initial stabilization and also wanted to wait and see if my body could repair my spleen. They didn't want to remove it right away. Kept my left humerus in a temporary sling/plaster. By the end of the ninth day my spleen got stabilized, saved...

Then they transferred me to a hospital with better operational assets and operated on my left humerus. They screwed the fractured pieces together on a titanium plaque running along my arm. The operation was exceptionally successful but then we saw that I also had nerve injury. TBPI.

My hand was almost fully functional, the main damage was to my shoulder groups. I had a small amount of biceps functionality (actually it was mostly brachialis looking like biceps), almost no triceps and no deltoid at all and no rotator cuff at all. They also ran me through EMG just to check if it would reveal anything but they also emphasized it was too early for a meaningful reading anyway. After three weeks of monitoring and antibiotics they finally got my neck MRI. After the operation the initial suspect was naturally root avulsion but seeing my MRI they congratulated me and told me I was lucky that my tubes looked intact and recovery was probably possible. After I was out of the hospital I started intensive physical therapy right away with a clinic recommended by my surgeon. They evaluated my functionality and I begun PT 5 days a week / 4 hours a day.

Around 2nd month post-surgery I got a second EMG that showed little and slow innervation in my triceps, slightly better biceps innervation, no activity in my deltoid (EMG operator only probed one face though) and no problems at all with my hand. My surgeon checked my bones and said everything was ok. Right after this control, I had slight movement with my anterior deltoid. Very slight movement in my triceps (1/+1 grade) and better control of my very weak biceps (-2?). Rotator cuff had very bad (grade 1) infraspinatus but the other groups were almost OK, especially supraspinatus. I also discovered my weak side caused some additional loss with back muscles related to my scapula.

More time passed, every now and then some muscles made some jumps. Around 4 months triceps started catching up and started to return fairly fast. Deltoid (dominantly the anterior wall) got better. I could raise my extended arm towards the front around 40-50 degrees. Scapular muscle groups got stronger, shoulder capsule showed relatively less frequent sulcus signs. I felt more stabilized with my shoulder joint in general.

It is now 6 and a half months. I can point my arm towards the ceiling when I'm lying (no gravity). I can raise my extended arm forwards around 60-70 degrees (I guess) but I use my scapula after some point. Posterior and middle deltoid are significantly weaker than the anterior. I have relatively better biceps (more control but still very weak, around grade 3), much better triceps (+4), slightly better infraspinatus (2?), rhomboids have been working since around 4 months and are now almost working properly.

My PT doctor evaluated me last week and told me since some of my innervations caught up with the rest and even surpassed most of these (i.e. triceps, scapular muscles) it can show that my primary recovery process is coming around the last corner. And since we still have way less functional recovery with the deltoid and the rotator cuff the probability that I may suffer shoulder deficits is potentially higher. And that after the check with my surgeon and a consecutive EMG test, according to the new findings I may need to check with a TBPI specialist surgeon.

The same day I got checked by my surgeon. He told me the bones were superb, I could even jump around with them. Heheh... Meaning my therapists can go all-out with my ROM exercises. He also told me I was recovering very fast and in a good condition and it was beyond his expectations. He told me 6 months was nothing to worry about, he had expected some proper movement around 1 year. Rotator cuff was still almost not working but that he had a corrective operation in his pocket if it didn't return. Overall, he told me he expected that I recover %90 functionality in 1 year. He wanted another EMG and I'm going to get it done soon.

I think I lurked the forums too much and accumulated so much to write to you. I apologize for the long and boring post.

Well, I am confused now with how to proceed. My orho surgeon is one of the best around and has a good reputation even internationally. An expert in shoulder. My PT doctor is also a good one. But I think they have different thresholds for evaluating my condition. It is superb recovery for my surgeon while I may need some serious intervention after this point according to my PT doctor.

My physical therapist (very experienced), PT doctor and surgeon all think I have suffered most of the damage to my C5 and C6 trunks (axonotmesis) probably under twisting and stretching forces which spared my hand and forearm functions.

I feel confused. How do I decide? How do I proceed? Should I see another doctor, experienced exclusively into TBPI? And yet, my ortho surgeon is very experienced and seen a lot of cases. I can't evaluate my condition. You know you need to interpret the doctors interpretations too.

: (

Thanks for listening.

And hi again.

Wow-you sound pretty lucky. I guess, from reading the posts, I feel pretty unlucky. I lost c5,6 and 7 20 years ago and back them there was no "team", you either had your elbow fused or you were SOL To raise your arm above your head even laying down is a dream to me. I am a female, in a small town, in pain and very little movememt. To all that had this injury recently you are very lucky!!! BPI have come come a long way. bitter? YES!
I go Mayo next month.................again for my 40 some trip!
Kath

Hey... I am also new to this... accident 12/6, similar injury, yet from a car accident. I have spent countless hours researching in the past week as my pain has worsened and my PT wasn't working. I am seeing an ortho surgeon and a neurosurgeon, but leaning towards the neuro. It can't help to have an expert, the one I'm waiting to see deals w/BPI and is highly recommended... being a nurse, my thoughts were... if you had a car that broke down would you want someone who had worked on your type of car, or soemone who has helped fix a few??? the other thing that you need to keep in mind is the trust in your dr. good luck!

Hello,

Although we arrived at our current place by different avenues (yours was a MC accident, mine was shoulder replacement surgery)our progress thus far has been very similiar. After having absolutely no movement for two months post-op, I now have fairly good use of my bicpes, triceps, wrist and hand. My shoulder, however, (like you) is a different story. I have very little use of my deltoid and upper back muscles, have a sulcus and severe muscle wasting. X-rays last week show the replacement has shifted forward in the socket, most likely due to the nerve damage (no nerves innervating the muscles, no muscle strength to stabilize the replacement).

I have another EMG on 1-22 and a CT Scan on 1-22 and then will decide whether a nerve graft is needed.

Maybe after your next EMG a more concrete decision will have to made as well.

Good luck!
MB

Today, I had another EMG. I want to tell you about it but first the replies...

herff94, I'm really sorry to hear how you feel about your chances. Yes, medical world seems to be relatively more interested in BPI cases. But it doesn't look like there has been a breakthrough with its treatment for such a long time. It sounds weird when you say it but I think most of what happens after your injury depends mainly on your luck. People with massive resources don't get to get better while people with the most serious brachial plexus injuries get better just on good will. I am not messing with your bitterness or just 'being polite'. I just wish you all the luck and a strong mind to deal with all this. I hope your Mayo appointment goes well.

Hi, kmartens. Your reasoning about the doctors is sensible. But I've read, heard and told that the experts in this area are usually ortho surgeons since they encounter this type of cases more than any other. Neurologists are into different stuff. If you come to a point where surgery is needed there is naturally a team consisting of orthopedists, neurologists and maybe doctors from other disciplines. I'd say stick to the most experienced ortho surgeon you are recommended. Just my idea.

MB15, I think I can imagine how you feel since your injury sounds similar to mine. I've been hearing from my PT people that shoulder replacement operations are very complex and recovery is also a complicated process. I actually couldn't get the mechanism behind your injury; is it caused by the operational trauma? Or you had some nasty fracture (resulting in TBPI) with your shoulder and it had to be replaced?

I had almost perfect hand movement first day after the accident. The rest is the same with you. No triceps, almost no biceps, then coming back, slowly... No deltoid, only some shoulder groups.


Finally, I had another EMG today with an old expert on this. I don't know what to think. Actually I just don't like what I'd think. Anyway, triceps is coming back, biceps is coming back; innervations in these are ok. But still no deltoid. What's worse is what I thought was deltoid movement seems like rotator cuff giving a hand. My deltoid has probably been totally silent since the accident. The doctor told me my C5 and C6 roots were partially avulsed, which means they have somehow found their way and started to grow. Some back muscles have started to innervate accordingly but they haven't reached the deltoid yet. He thinks they will probably go on and innervate the deltoid as well but the extent of the damage that will stay with the arm cannot be told. He told me it will probably never be the same with my right arm again. The extent of recovery can be anything except 'totally normal'.

I asked him about any possible surgical intervention, just what to think about it. He told me the highest target of most operations is the point I have now reached. So he thinks risking a surgery and the trauma related with it is insensible.


In short, he thinks my arm will get better than it is now but there will most probably stay something wrong with it to some unknown extent.

I can neither feel happy nor sad... Feels just weird. I have got relatively better and it seems it will relatively get better eventually. But you cannot even start to digest the idea of irreversible damage, regardless of its amount. Hope is what keeps this running. Today I lost some amount of hope to good old solid facts.

I just wish you all the strenght, all the peace of mind you can muster and especially the best of luck with your hopes.

GREAT!!!! Sounds like things are coming along.
I did receive the best treatment from the get go. I was flown to Mayo after I was released from the hosp. Even at Mayo Clinic the resources and knowledge of BPI weren't heard of, this is back in 1987. I had a world known doctor preform a muscle transfer on me. He later became the CEO for May Clinic. I feel grateful for what he did for me.
I must have had a bad day when I posted that last note. It's a difficult injury for anyone, no matter the extent of the injury. Its life changing.
Good luck and I hope more success comes your way in getting strong and better.
Kath

motormonk,

My mechanism of injury was surgical trauma. 2% of people who have shoulder replacements suffer nerve damage as a side effect...lucky me!

I'm glad your EMG showed progress but I know what you mean about the bottom line...that your arm/shoulder will never be "normal" again. Let's hope you get pretty damn close, though!

I think I may be looking at another surgery, regardless of what the EMG shows, due to the shifting of the replacement. That will be a very scary bridge for me to cross.

My EMG & CT Scan are on the 21st, not the 22nd as I posted. I will let you know how it goes!

Hang in there!
MB