United Brachial Plexus Network, Inc.

When your muscles start coming back after surgery. How do you start moving the arm again? do you have to retrain the muscles to start using them or it just happens?

Thanks,

Susana

Good question, any one know about this??
Courtney

Ok here goes my explanation. Ver rudimentary but....Any muscle that isn't used for an extended period will atrophy - the longer there is no use the worse the atrophy. On top of this, the nerves in a tbpi person haven't been talking to the muscles for some time. So although your muscles will have some memory you will have to retrain them. For instance my biceps came back fairly quickly but the triceps only in the last 6 weeks. I have been doing bicep curls in therapy but they are pretty unsteady because even though the bicep does the bulk of the work in the movement others assist. If the muscles that normally assist aren't working the bicep has to figure out a new way to complete the motion. Other muscles that normally don't assist or assist minimally may start assisting more. In the case of the bicep curl the triceps usually kick in to lower the arm but since mine weren't working the bicep would slowly release and gravity would lower the arm. Certain actions though can only be performed by certain muscles. My rotator cuff muscles aren't working yet so the shoulder is unstable so the bicep curl is unstable. Most movements of the body involve several muscles so if even one of them isn't working then there will be some relearning.

Muscles don't have a memory as such, otherwise people who have had muscle transfers from other parts of the body will be in real trouble!!!

The brain is the thing with the memory and there is a theory out there that after so many years, the brain forgets that it has an arm and how it works with all the nerves firing. I personally don't believe this since I know of a couple of people who have had muscle transplants in previously 'dead' limbs that have worked without much delay. In these cases, other nerves attached to other parts were used to innervate these muscles and it was the brain that had to be re-trained to operate them in a new way.

As soon as a nerve graft reaches the motor end plate of the muscle it has been directed too, the firings in the nerve will start to awaken it...even after some pretty severe atrophy, although obviously, if the muscle has atrophied to such an extent that there is hardly anything left, then there will never be any strong movement. (This is when muscle transplants could be used in certain circumstances)

After a resting period of some weeks following a nerve graft, (allowing for some growth of the nerve )there will usually be an intense regime of physiotherapy to get the arm supple again, after that it is just a waiting game until the nerve reaches the motor end plate...but you guys know all this already. What the therapist will encourage you to do is work the arm muscles doing passive or ROM movements and this will maximise the chances of the nerve graft working.

When my bicep starting flickering, every day I tried to flex my elbow at least 4-5 times a day and after a while, I could lift the arm against gravity. It took a few months to get it to maximum strength tho...so, for me, just excercising the muscle by trying to force it to do what it should worked for me; the muscle is just something that needs waking up and 'telling' what to do with a nerve.

Liz B

PS I agree that you need the triceps for full and strong elbow flexion..along with other muscles involved normally. All muscles work in pairs, and if one of the pair is compromised by nerve damage, then the the movement will never be really complete.

I had a latissimus muscle re- routed from my back, up under my armpit, down through my bicep and hooked up to my inner forearm due to a tbpi. I can now bend my arm as I couldn't at all before. For the first two weeks apprx, I had to really concentrate on the top of my back where the muscle starts and after that it came naturally. It takes a bit of mind power but it will happen. If you have any more questions give me a shout.
Mark

Susana~
I had a muscle transfer to get some movement. My bicep was gone, so the Drs took my tricep and connected it to were my bicep was. I didn't need my tricep because its ability is to pull down....well, I couldn't lift my arm to pull it down. I was in a cast for 4 wks, removed my stitches, and a cast for another 4 wks. Then therepy twice a day for about a month and then I sow slight movement but once I figured out I had to think to "straighten" to bend my arm my brain figured out the rest. It seemed like forever going through it but when it happened I was like "Oh, my gosh!!! Did you see my arm move????" It was a mircle to me! I only have elbow flextion and to lower it I slowly release my muscle, but it saved my hanging useless arm.
It'll happen and when it does then its a piece of cake......and alot of work:)
Kath

Mark or Kath,

After reading your replies, that is what I try to do all the time. I concentrate on my wrist, hand, fingers and elbow to move and I get all tensed up and actually begin to shake. BUT...my nerves are stretched. So if the nerves are not connected, how could my fingers, etc. even move if there is no connection of the nerves? Am I trying for nothing and getting myself frustrated to hell for nothing? I guess this is why I am seeing a BP specialist in December? Do you know as well, with stretched nerves could there be possible surgery? Thanks. Karen

The EMG will tell you what muscles are innervated or not, but don't freak if they aren't innervated, they can become innervated later and with a stretch its more likely they will become innervated at some stage.

Hey Susana
I have had the nerve graft surgery done a year ago. When I saw my surgen 7mo post surgery he detected a flicker in my deltoids and recomended ''agressive physical theropy and e stim '' to help strengthen the muscles in my shoulder. My therapist told me that estim will hinder nerve regrowth but once it has continuaty itis OK to e stim. It seems to be working as I am getting more movment and strength back in my shoulder. Can't wait till I get some bicept back, then who knows what next. Red

Karen, my injury was originally thought to be just stretches but when certain muscles weren't showing signs of coming back my Dr. scheduled exploratory surgery. What he found was scar tissue on the radial nerve that was blocking regrowth and a severed axillary nerve (serves the deltoid). He removed the scar tissue and did a nerve transfer for the axillary nerve. Won't know for a few months if the transfer worked but am already seeing a lot of tricep as a result of the scar tissue removal. I am having a 2nd exploratory on 11-11 so he can look at the subscapular nerve - he couldn't access it all of it during the 1st surgery because of my position on the table. I am lucky because I don't have avulsions but it is still a long haul with no guarantees. Its been 9mths and I'm told it will be 2-3 years before I'll know how much use of the arm I will get but I'm hopeful.