United Brachial Plexus Network, Inc.

Subject: Weak Pulse.

Hello,

I just discovered this site while attempting to find a solution to my arm issues. I was looking for information regarding poor circulation in arms with a TBPI and stumbled onto this site and look forward to conversing with others in the same boat.

My problem is a dramatic difference in skin temperature in one hand. On a cold day my TBPI affected arms skin temperature will get down to 45 degrees while the other hand will maintain 65 to 70 degrees. As you can probably imagine this is quite painful. Gloves help only a little since insulation doesn't create heat only retains it.

My injury is complicated by a subclavian to brachial artery bypass that may be causing reduced blood flow resulting in the cold hand.

Until last year I always assumed the twelve year old TBPI was the reason for the cold hand until I noticed that I have very very pulse in the right (TBPI) arm. The pulse is so weak that doctors and nurses have had to resort to a Doppler radar device to pick up a pulse. I like to engage in extremely vigorous aerobic activity, during such activity my blood vessels in the other arm with be bulging and you can literally see my pulse on my left wrist, so I do not think an overall weak cardiovascular system is to blame. At first I thought that the artery bypass and graft was to blame so I had a MRA and a other tests done and ended up getting a embolectomy done on my forarm. At first I thought it was better but that was one year ago and now I think it is worse than ever. One of the complications of the vessel work is the risk of clotting and I am thinking clotting could be the reason the problem has returned.

I am hoping some other people with TBPI can share some details of their condition with me and everyone else for that matter, my injury is complicated by the vessel damage and is making it hard for me to determine what the best course of action would be, this could be par for the course and I hope to find out if it is on this site.

I assume that everyone has a differing degrees of lasting damage, I was pretty lucky and went from completely limp and useless to pretty good return of function. If you do respond can you please rate the severity of you TBPI.

Question one- Do others have equal pulse and vascular systems from one side to the other.

Question two- Has anybody had problems with blood flow to a TBPI affected arm and found that exercise or massage has helped.

Any help will be greatly appreciated.

Thank you,

Dex.

Try putting a handwarmer in your glove this is what I do for my son you can buy them in the camping section of walmarts or any big chain stores they are small gel pouches that you toss in the microwvae and they last for hours. Mare

Massage is good, it increases circulation as does heat. If you can get those microwaveable heat pads (the ones with beans in them?) and put that on your arm.

Marieke (32, LOBPI)

Hi..to answer your questions; I have a very weak pulse in the right (tbpi) side compared to the left. Many Drs seem to have difficulty in finding it, but the average nurse doesn't, which I find quite odd (maybe nurses take a pulse more often than Drs)

I do have a very cold hand in winter/cold weather but equally, I have a very hot hand in the same conditions sometimes. Massage and stretching, particularly pulling my arm up as high as possible helps enourmously.

I never did have vascular damage to the BP but I do have all five nerve roots of the plexus avulsed.

Incidently, taking a blood pressure reading from the TBPI arm shows a different reading from the other arm. Sometimes, it's particularly high, which was a surprise. The nurses who have taken it both sides, (just for the sake of experiment and no real medical reason)are of the opinion that because the arm is wasted, with no muscle left at all to speak of, the blood pressure cuff can squeeze a lot harder..difficult to explain, but I think you can get the gist of it.

Hope this helps.

Thank you for your response. I have done some research since I posted the first time and found out a few things that explain a lot of the problems. The main problem we have is the veins that are lower than your heart have muscles and valves to keep the blood flowing back to your heart, if your nerves are not firing then there is no way for your blood to flow back to the heart unless you raise your arm and allow gravity to assist. The venous side of the cardiovascular system operates at almost zero pressure, apparently the heart pumps the blood out to the extremities and gravity and veins pump it back, if the blood is not moving out of the veins then new blood will not be able to flow into the arm, others on this site have mentioned swelling, probably due to the veins not functioning properly. It sound like you have already figured this out, I just discovered that raising the arm helps to get fresh blood and heat into the arm, I always resorted to shaking and dangling it at my side making it worse not better.

Perhaps the blood pressure is higher in the TBPI arm when the blood is backed up in the veins. I think I am going to try getting some BP readings in different positions to try to see if my theory holds water.

Your injury sounds more severe than mine, I actually have quite a few areas that have revovered, in the areas that the sensation is absent the veins are invisible probably because thet have lost the muscle in that area, in other areas you can see them go to work when I hang the arm way down below my heart.

I feel pretty dumb for not having figured out the raise your arm to warm it up sooner. I used have a really hard time getting it back up to a reasonable temperature at least now I know the secret.

Thanks again for the reply.

Dexter.

Hi Dex,
My name is Scott. I gotta tell you straight up that for me taking a pulse on both wrists is very amusing. I can't do anything with my left shoulder, arm, wrist or hand. I tried taking it (right pulse) with my nose but couldn't get a good read...other than I really amuse myself sometime and ridiculously so. Along with tearing my shoulder up(rotator cuff), fracturing my scapula, dislocating my shoulder and whatever I did to LBP I believe my elbow to be a little distressed as well. I keep my arm snugly wrapped in a 'both shoulder' type strap and usually my hand has a glove on it. Doesn't really work well but in my mind it really has to so for the most part it does. Hope you can hear what I'm seeing and see what I mean? Massage from the right person at my VA appoint. is shear ecstasy. So unbelievably wonderful. She uses a lotion/cream called BioFREEZE.
As far as bp cuffs on my LTBPI, not gonna happen. You come near me from the left side I will make a mama bear protecting her young look tame. I reckon I am the only one here with a super sensitive limb? I'd sure like a reading on that one from folks please?
In the mean time why doesn't everyone who reads this please go to
freerice.com
and be truly amazed at what you can accomplish and learn especially this time of the year. Go ahead try it. I'll bet you'll like it and, furthermore you will pass it along to not one person but every person you've ever met and kept in contact with. Then for your amusement (not just trying to take your pulse with your nose) take a look at the totals and be truly amazed.
I apologize for straying off topic but Dex As you get to know me you'll learn I have a tendancy to wander.
Peace and Goodwill out,
Scott
PS FREE THE FREE RICE!!

"the main problem we have is the veins that are lower than your heart have muscles and valves to keep the blood flowing back to your heart, if your nerves are not firing then there is no way for your blood to flow back to the heart unless you raise your arm and allow gravity to assist."

Just to help you understand a bit better... your veins do NOT have muscles to help bring he blood back to the heart. They have valves that open and close to allow blood to the heart and not "leak" back, BUT it is YOUR muscles that help pump this blood. So every time you move your muscle contract and help pump blood back to the heart. So if you have less movement due to an injury (paralysis, even partial) your muscles will NOT be contracting and the blood will NOT flow back to the heart easily and so doing massage, ROM, and things like that will help your blood get to where it should and keep your arm warmer.

http://www.fi.edu/learn/heart/vessels/veins.html

Marieke (32, LOBPI)
http://nurse-to-be08.blogspot.com

hi dex
I'm 27 years post accident and have no use of my right arm. It's always cold and in fact in camping trips to the bush I've got dangerously cold, the bpi arm gets so cold it starts kind of spreading into my chest. BE VERY CAREFUL with those heating pads you can get from stores if you have no feeling in the skin of your arm/hand, this skin gets burnt really easily, and I do mean burnt, with blisters just from something like a heating pad.
The coldness, lack of sweating, inability of the arm hairs to stand up or react to temperature together with the sluggish blood flow are all caused by damage to the autonomic nervous system, the one that just carries on doing stuff when you don't think about it like sweating, opening and closing pores, erecting hairs when it's cold etc. So please be careful if anyone who can feel their arm recommends any form of heating to you, if you have no feeling in your arm that is not always a good idea. Never ever wrap it up with something warm and forget it, keep checking for burns. The danger of burns and injuries I don't feel is the major reason I'd like to have it amped now.

As far as hypersensetivity goes, I only have that in the one bit of my arm that has feeling, the back of the upper arm. I can't bear to be touched there at all. Funny thing is, when some things happen, I can't 'feel' it in the rest of my arm, but I can feel it elsewhere due to cortical remapping, ie the bits of my brain formerly receiving sensory input from my hand have been taken over by neighbouring bits of my brain which deal with sensory input from my face. If I gently scratch the palm of my bpi hand, I feel it in my neck and chin. I can't feel it at all in the hand. Other weird stuff to check if you have a 'dead' arm are no fingerprints, crumbling, ridged nails you can just peel off, shiny transparent skin (I can see the veins and capillaries through the skin of my hand).

such an entertaining injury! Hope you guys manage to survive the cold winter, I'm currently struggling to avoid sunburn most of the time but I really hate the winter so I don't envy you. Christmas in summer truly sucks tho, I'd be prepared to have a bit of cold just until after the 25th

Take care all
Jen NZ

...and the free rice is great, I'm totally addicted and have given loads of rice away in my efforts to increase my score!
www.freerice.com

I keep reading about muscle in the veins. This is from the site that you referenced in your post.

"Like arteries, veins have three layers: an outer layer of tissue, muscle in the middle, and a smooth inner layer of epithelial cells."

It does not state that the role of the muscle in the veins is to transport blood though, that was just my asumption.

I can report that since the first post I have been lifting weights weights overhead with the TBPI arm and doing a variety of other dumbell exercises and the arm is getting alot warmer all of the time. I know this is not an option for alot of people with a TBPI but for those with significant recoverery it does seem to help.

I think in my case I had grown so used to favoring the healthy arm that I never worked on using the arm beyond what is comfortable. Perhaps the overhead workout is allowing me to see the increased bloodflow to the muscles that are firing since the gravity is evacuating the the used blood allow fresh blood to flow in. I will continue to do these exersises. I am hoping the arm will respond by increasing the overall capacity of the vessels in my arm to keep up with increasing demand for blood.

Thank you for you reply,

Dex.