United Brachial Plexus Network, Inc.

Seems from my reading, neither MRI or EMG provide a fool-proof way to tell the extent of the injury or if nerves might be slowly regenerating on their own. Am I right in thinking one risk associated w/nerve grafting is negating growth that might have already been occurring - and having to start over at the source with the grafted nerves? Plus that ticking "muscle atrophy" clock in the background...

Why don't more people have exploratory surgery to determine exactly what is going on? Do doctors or insurance not want to do this? Or is it not really helpful/necessary?

Given my 15 year old's completely flail arm at this point, we don't want to delay surgery if nothing is progressing naturally - but certainly don't want to jeopardize recovery that might just not yet be evident. (John's accident was 2 months ago.)

I'm in the market for a good crystal ball!

Thanks!

Hi,
I was told after an mri that i hadnt avulsed any nerves,but after exploratary surgery i had avulsed c5,6,7, so in my opinion it doesnt harm to "go in" and have a look as you say the clocks ticking.

karl

One problem with exploratory surgery is scar tissue. Scar tissue is not a friend to the BP injured person! Not to mention the added risks of anesthesia. I have such a difficult time with the IV's, anesthesia and the whole recovery room thing. I realize that exploratory surgery would fall under "minor surgery". However, as far as I am concerned there is no such thing as minor surgery.

Its each to there own joy, But what do you do sit and wait for something to happen? If its for the good of the cause sometimes you have to make sacrifices,If you broke a bone you wouldnt leave it to heal naturaly so whats the difference

Hi

I don't know if this helps but in the UK exploratory surgery now is usually done within a matter of weeks because, as you say, MRI scans and EMG nerve conduction tests don't always show the whole picture. It is pretty normal to wait a few weeks simply to see if there is any change or any sign of recovery from say a bad stretch. When they go in for a look, if they are still unsure, it is possible for them to do nerve conduction tests directly on the exposed nerves, then make decision whether to do any repair work or not.

I think the waiting game and whether or when to do the exploratory relies to a certain extent on the experience of the surgeon, the circumstances that caused the injury in the first place and just plain gut instinct. If it is recommended, I'd go along with it. Good luck with whatever you decide to do

Liz B

EllenB.......to some degree its a crap shoot without the surgery. In fact, its mostly a crap shoot. The debate on EMG's & MRI's seems to go on forever, but my personal belief is that neither of them will give you all the info for a 100% diagnosis. I had one MRI and two EMG's in the first three months of my injury. At the three-month EMG the doc told me that nothing had changed in my "flail" status, and gave a grim prognosis. I started getting worried and looking into surgical options, but at five months my muscles started to wake up, so I chose to wait it out, for obvious reasons. My arm and hand is probably back to around 70%, and believe it or not, it is still showing signs of recovery.....after 3 plus years. I'm not telling you this because I'm an advocate of the "wait & see" doctrine, unless there is VISIBLE evidence that some degree of recovery is happening. I took a gamble. I won. HOWEVER........if I knew then what I know now, I would definately let a doc go in and have a peek. I would want to know for sure. I don't like to gamble. And you can bet the doc I pick would be the best. Hope John's recovery is swift and painless.

George

Hi Ellen

I'm not an expert (I've only been through this once) but I recommend having the exploratory. You are still within the ideal window of recovery for nerve graft surgery. In our case we were pretty sure there were total avulsions. I think the level of pain (especially in the hand) is a pretty clear indication of this. I do believe that once the surgeons are "in there" they can tell the exact status of the nerves. We had MRI, a few EMG's and CT mylegram.

P.S. I emailed you...sorry for the delay.

Yes Karlos it is to each his own. I read the original post as a person asking for opinions on exploratory surgery. I gave my opinion, which is clear that I would hesitate to have exploratory. Not that one should not have exploratory but I would exhaust my resources before going down that road. I listed reasons to think about before going in.

I spent 18 months and over 10 doctors trying to find someone that had a clue as to what my problem was. After I found a doctor that knew what was wrong it was still two more before I made it to the final doctor. I would drive 2 and a half hours, one way, to his office at which time I would sit in his office for HOURS (between 8 and 12) just to see this man. That did not include the therapy appointments or testing appointments. I spent from 1991 to 1996 doing nothing but appointments after appointments. I have had three surgeries alone for my BP injury. Not to mention the varied other to correct health issues. My point... I have never been one to sit and wait and see if something happens. I don't think I have met anyone on this board that does.

Perhaps, I should have waited until morning to respond, when I was not in so much pain. But, of course there is no guarantee that the morning will be any different than tonight.

Joy

Thanks for your responses. One reason I posted the question was because typically I don't see anything posted on these message boards about exploratory surgery - instead I get the sense that the choice to have nerve grafting/transfers is made in a bit of a vacuum (i.e. not knowing if normal healing might already be taking place).

So I wondered if doctors or insurance don't recommend or cover this type of preliminary surgery. To me it makes sense to do it before more invasive options are scheduled.

Also, re scar tissue - one doctor told me the exploratory surgery would be one way to clear out scar tissue so normal healing could progress... as opposed to creating more scar tissue!! Help!

Thanks, all, for your comments.

Hi Ellen...the surgeon probly means clearing out scar tissue that has fomed on an injured nerve in it's attempt to heal itself..as I found out recently, this surgery is a bit controversial since some surgeons (and other people involved with this injry) think that the scar tissue, or 'neuroma' could contain nerve fibres that conduct signals....sorry! even more info to add to the confusion!! ;0)There could be other scarring or adhesions in there that are preventing normal conduction...no-one will know for certain until they get in there and look.

The scarring caused by the exploratory itself is very minimal...my incision scar is totally invisible and was from about the 3rd year post op. I only had a neck incision..sometimes they take nerves from the leg to graft the nerves; this can leave quite a big scar, but it is near the ankle so easily covered wiuth jeans...this scar also fades in time so I'm told.

Hope this helps....

Liz B