A lot of people ask Tom questions regarding his injury and surgery he had back in 2011. Many patients with nerve injuries are keen to understand how their injury differs from others. In regards to nerve injuries in general, I would say no nerve injury or recovery is ever the same…. they are very individual and nerve regeneration is something that can vary across a wide spectrum. It is, however, easier to understand why an individual has limited movement or function by comparing the severity of what was damaged and also what was attempted to be reconstructed during surgery.
Tom had a catastrophic brachial plexus back in 2011 and was air lifted to Morriston hospital directly. This is the specialist centre for nerve injuries in Wales. He was immediately assessed by the Brachial Plexus Specialist Surgeon and a decision was made quite quickly to operate. This was a very long procedure that needed a team of surgeons to complete the complex task.
Once on the operating table, they found that C6 to T1 (cervical to thoracic spine) had avulsed at the spinal root level meaning no operation was able to salvage these nerve levels due to the severity of the injury. C5 nerve root was present, but also badly damaged with only a flicker of movement in one muscle when electrically stimulated.
In these type of injuries nerve transfers are favoured in order to regain muscle activity and to attempt an improvement to function. Tom’s distal accessory nerve was transferred to his suprascapular nerve in order to try and gain shoulder stability, his damaged C5 nerve root was nerve grafted (sural nerve) to his median nerve in attempt to assist hand sensation. The surgical team also borrowed three of his intercostal nerves (nerves that assist deep breathing) to try and gain elbow flexion by transferring them to his musculocutaneous nerve. The diagram below gives a visual picture of the injury and how his nerve transfers and sural nerve graft have attempted to regenerate nerve stimulation.
In summary
1. Distal Accessory Nerve → SupraScapular Nerve
2. 3rd/4th/5th InterCostal Nerve → MusculoCutaneous Nerve
3. C5 Root →Medial head Median Nerve (C5) → via a Sural Nerve graft
Tom was kept in Morriston hospital for a few days to make sure his pain levels were manageable after the operation. A lengthy spell of physiotherapy followed this. His rehabilitation lasted years and consisted of many modalities including splints, hydrotherapy, passive stretches, strength & conditioning and exercise therapy. Throughout this time, Tom focussed his energies by developing his first cycling arm brace, which certainly assisted in his rehabilitation mentally and physically. He has a stable shoulder, but limited active movement in his shoulder and elbow, making the brace essential while hitting the mountains hard.
There are many ways surgeons can graft, transfer and utilise muscles/tendons in your body after a Brachial plexus injury, the decision should be made with you and hopefully you can understand your recovery through the process of therapy. Outcomes from nerve transfers at the brachial plexus are limited due to the distance and time it takes to regenerate and recover, this can be very frustrating. A combination of a skilled surgical team, long-term high quality physiotherapy and self-motivation to develop the best possible quality of life after injury are essential.