United Brachial Plexus Network

I am writing about my husband jim. he is the member on this website. his injury occured 2/12/06 and suffered a severe rbpi with no feeling or movement in the entire right arm or hand. he had nerve graft surgery done at the univ of penn with dr. zager yesterday. all 5 nerves were intact however the dr said it was very severe and all 5 nerves were "dead" when he performed the emg during surgery. he did a nerve graft on 6,7,and 8 and we are hoping to regain function of his shoulder and elbow over time with the graft. he said that chances of hand recovery are low and that nerve graft surgery can not be done to repair the hand function because of the length of nerve graft needed. any thoughts on this? i did ask him because all of his nerves were still intact, could he eventually over years regain that function and he did say it was possible but slim. anythings possible right. i thought that if the nerves werent avulsed (spelling), that recovery should happen. any thoughts or remarks about this are appreciated greatly. jim is feeling ok, pretty sore but he will be coming home tomorrow.

You might want to consult another MD such as Dr. Nath. Doctors have varying opinions on what might happen. It does take a long time for a nerve to grow to the hand. In the mean time, the muscles atrophy so much that a muscle transplant is usually done. This does not give fine motor control. It only gives grasp function and some ability to lift. Better than nothing. However, I would definatly talk to someone else. I have found Dr. Nath (Houston) to be very helpful. Michele

Hi - it's true that muscles do atrophy pretty quickly, which is why it's good to have surgery before six months post-injury. My son lost all five bpi nerves, had surgery at ~3 months, and while waiting for the transferred nerves to grow to the target muscles, he did electrical stimulation ("e-stim") therapy every day at home as well as at the therapist.

E-stim works off a battery & sends a small charge that causes the muscle to contract. Most doctors feel it helps keep the muscle viable until it can be innervated again.

I've never heard of people doing e-stim on their hand muscles (John did bicep, tricep, deltoid) - but it might not hurt to ask your doctor's advice. Our insurance paid for John's unit w/o question so it must be an accepted form of treatment...

Excellent doctors to consider contacting include Mayo Clinic (who have cared for John) as well as Alan Belzburg, Dr. Tiel, Susan McKinnon. Their specialties include ortho, neurosurgery & plastic surgery.

Hope this helps,

Ellen

Was just reading the part about e-stim and it can be used on hand muscles. I currently use e-stim on my finger and wrist extensors. We have also tried the lumbricals in the hand (the muscles that make forming the table top position possible) Mine are either screwed up from surgery in my hand or too atrophied to respond to that e-stim. So it Stickto using it for finger and wrist extension. Works very well.

Amy 19 ROBPI from MN

Hi,
I had nerve grafting surgery in Sept 02. My situation is a bit different but there is still plenty to learn from my results.
I avulsed all 5 nerves on the left arm but because I amputated my right arm and shoulder in the accident, the surgeons had all the nerves on the right side (which were cut off at about shoulder length) available. They used nerves out of the back of my legs as well as the ulna in my paralysed arm as grafts. They did 4 17.5cm grafts across the front of my throat and plugged my right arm nerves into my left arm.
11 months after surgery I got the first flicker of movement in my bpi arm. All the other grafts have been very slow at getting results and any results have been very weak.
What has happened is the graft that they used the ulna nerve with grew very rapidly and reached my hand before it withered to much. Apparently this was so successful because the ulna nerve is such a big healthy nerve compared to the ones from my legs, but also it was vascularised (it was transfered with it's own blood supply) The downfall of harvesting the ulna nerve is if you do get function back in the hand, you are limited because the ulna nerve controls the little finger, part of the thumb and stretching apart of the fingers.
So for me I've got a strong bicep bend, but virtually no straighten (tricep), very little deltoid so no out of he side of the body, I can pull 3 fingers in but can't straighten them at all (so they're alway in), no rotation ( my palm is always facing upwards)
Like everyone my main problems (apart from the obvious) are the nerve pain, and the weight of the bloody thing!!!
I've just see my dr's again in Sydney, and they are talking about more surgery in the arm and hand to try and give me some function. They are limited though because there isn't enough in the lower arm yet to do a tenton trasfer of anything (that was to pull my fingers straight so I could pull against them)
Next visit they will fuse my thumb in a more acceptable position, but other than that it is still a waiting game, because he belives I haven't plateaued yet.
All in all they discovered how superior a vascularised nerve is.
Thanks for listening!