C5 Rupture / C6-8, T1 Avulsion

This forum is for discussion about adults Brachial Plexus Injuries due to trauma injuries.

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C5 Rupture / C6-8, T1 Avulsion

Postby HeidiP » Mon Dec 26, 2005 12:07 pm

In June of this year (2005) my husband was in a severe motorcycle acccident. One of his injuries was a brachial plexus injury to his right (dominant) arm... rupture of C5 and avulsion of C6, C7, C8 and T1. He has had no movement or feeling in his arm since the accident. On December 9th he underwent surgery at Mayo Clinic in Rochester. They reconnected his C5 nerve using a sural nerve graft, implanted his gracilis muscle from his left thigh into his right arm and used 6 intercostal nerves (4 motor and 2 sensory) to supply power to this muscle and ultimately feeling to his thumb, index and middle finger. While this was a major surgery - almost 12 hours, we are very hopeful that it will result in a functional right arm for my husband. I cannot say enough positive stuff about the folks at Mayo clinic. They were awesome!
Through our faith in God and the people that He is putting into our lives... whether it be friends, family members or medical personell, great things are happening as a result of this injury. (Only God can turn something tragic into something good.) :wink:
While no one except someone who has suffered this kind of injury can begin to imagine the pain that accompanies it, we are thankful that God does know and understand and will never leave us alone to deal with anything. We also know that He uses us through our experiences to help others. Because of this, we would like to offer our encouragement and prayers for anyone out there who is going through this kind of injury.

(Psalm 46:1 God is our refuge and strength, always ready to help in times of trouble.)
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nerve graft

Postby jesshaa » Sun Jan 01, 2006 4:10 am

I am interested in the nerve grafting you spoke about. I am wondering if you have more information. I was told my 2 yr old daughter was too old for that suregry because the nerves were not as responsive past a certain age. I am hoping also that it providers function for your husband. I understand the dramatic impact of an injury such as this. Please let me know more information and how it turns out for your husband. Good luck and God bless!!! :D
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Re: nerve graft

Postby FrancineLitz » Sun Jan 01, 2006 11:35 pm

jesshaa wrote:I was told my 2 yr old daughter was too old for that suregry because the nerves were not as responsive past a certain age.


Jesshaa - the way I understand it (and of course I may be wrong) is that it's not about the age of the person, rather the time since the original injury. The muscles can live without a nerve for approximately 12 to 18 months from the date of the injury and recovery time from a surgery has to be included in that timeline. Nerves grow approximately 1" a month so it's a slow process.

When your daughter goes for her mod quad, Dr. Nath will certainly tell you what else can be done to help your daughter's recovery.
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Postby HeidiP » Tue Jan 03, 2006 3:59 pm

jesshaa,
I am by no means an expert in this area, and have not researched obstetrical BP injuries at all.
From everything we were told, nerve grafting surgery, such as what my husband had, needs to be done within 6 months of the injury for the greatest chance of success. This was a radical procedure because 4 out of the 5 BP nerves were avulsed (pulled out of the spinal cord at the roots). The 5th nerve was severely damaged.
I wish I had more information for you. From everything I have read about Dr. Nath, he does seem to be a leader in the BPI arena. I wish you and your daughter all of the best. I would be happy to share more details about our experience if you are interested in this kind of thing.
God bless you.
HeidiP
Psalm 46:1 God is our refuge and strength, always ready to help in times of trouble.
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To Heidi p

Postby JAY T » Thu Feb 02, 2006 5:34 pm

What test was given to find the rupture&avulsion in the nerves?


JAY T
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brachial plexus injury

Postby defaithed55 » Fri Mar 09, 2007 10:33 am

Last year i was in a horrible car accident, i ripped the nerves from the C5 to the C7 completely out of the spinal cord. i have no feeling or movement in my left arm. i underwent my first surgery at the end of January,(my accident was in July) I had my surgery in NY, I recieved a nerve transfer. i had nerves taken from my legs and ribs, hopefully to gain sensation and elbow movement in my arm. Everybody out there with a injury like this i understand when you talk about the pain. Somedays are surley better than others. i wish the best for everybody out there dealing with this traumatic injury. if you need or want any more info or just need to chat go ahead, it's good to have people to talk to that understand what we're going through.

carri
23 yrs, NY
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Postby mxrider4524 » Tue Apr 29, 2008 4:54 pm

On July 1 2007 I was in a motorcycle accident that left we with a laundry list of injuries, this one in my eyes the worst. October 11 2007 I under went 11 hour surgery to try and repair my injury. C5 and C6 were both ruptured, C5 being irrepairable. C6 was graphed into C8 using the 4th,5th,6th intercostal nerves from the ribs. C7 and C8 were avolsed and T1 was contigious? From the day of the accident I had no movement or feeling in my entire lefy arm/hand. Now i can feel to my elbow completely; hot/cold sharp/dull. My forearm and hand have a weird sensation when they are touched or moved, i know its happening but its not normal. I can move my entire shoulder and all my joints are very loose. I go to therapy 3x a week(thats all insurance allows) and work on keeping things loose and stretched in hopes one day I'll wake up and move my left arm again. It has been 10 months since the injury occured and 7 since the surgery, should I be worried things arent coming back? My surgeon, Dr. Stephen Russel in NYU told me I could expect to wait 6-9 months or possibly longer before I saw any improvements following surgery. Any insight would be greatly appreciated,Im a 20 year old guy and I wont accept this for the rest of my life, I just cant.... :?
It's Not The Hand Your Dealt But How You Play Your Cards
Never Give up hope, Everything happens for a reason
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Keep the faith

Postby HeidiP » Tue Apr 29, 2008 5:50 pm

MXRIDER4524,
It sounds like things are progressing well for you. I am so excited that you are regaining feeling.
It's "only" been 6 months since your surgery. From what we were told, that is very early and you are seeing results, slow, but results.
Unfortunately, it's been 2 years and 3 months since my husband's surgery. He has regained enough muscle tone in his shoulder to hold the shoulder in the socket. (the muscles had losened up so much that his shulder fell out of the socket continually) He only has some feeling down to about his elbow, and can bend his elbow to almost a right angle. His fingers are so stiff that he cannot really get any movement there. The doctors say that he is just one whose muscles tend to get tight very quickly. He is twice your age though, so you have time in your favor.
We have visited with a number of people with this kind of injury and several who have experienced remarkable gains in movement and feeling. I hope and pray that you will continue to make progress. Don't give up and don't lose heart.
Based on your signature line, it sounds like you have a good attitude. Everhthing does happen for a reason. Sometimes it is very difficult; however, continue to search for the positive side of things and seek to use your experiences to help others.
I hope and pray that you have someone in your life that you can talk with and share the hard times as well as the happy times. Whatever you do, know that your are not alone in this and don't let yourself be limited by what you can't do. None of us can do everything, so focus on what you can do!
God bless!
Heidi
Psalm 46:1 God is our refuge and strength, always ready to help in times of trouble.
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Postby mxrider4524 » Thu May 01, 2008 11:03 pm

Hello Heidi, I was so worried about getting the proper names in my injuries I forgot to mention my name;Travis. Yea 6 months since surgery isnt too bad, this is the time the doc told me I should start seeing results, although ive been seeing them since 1.5 months since surgery :)
I had similar issues with my shoulder your husband had. I left the hospital in a standard sling and spent 3 months in it to find out my shoulder has rounded forward and pulled from the socket just about. I did some research and found this, its called ARC Shoulder Brace. Google the image because this forum wouldnt allow me to post the linnk. It held me in the correct position and got my shoulder back to place. Im not sure if your husband still needs his shoulder worked on so if he does I thought i could try abd help. Also the fingers..my doctor stressed how important it was to keep everything; muscles, joints, tendons, very very loose so when/if the nerves came back the muscle rebuilding wouldnt have to fight the muscle tightness, causing the nerve growth that just occured to be almost a waste.
I have a brace that holds my 4 fingers in one position;their normal resting area, and the thumb to the side in its normal position. It extends from the wrist to mid-forearm. On the top of the brace and the bottom there are these hooks, and what I do is hook rubberbands around my fingers and the hook on the bottom for 2 hours. It creates a closed fist position, and that llong hold in position takkes away the hassel of doing a million manual stretches. Then later that day I'll do the same in the other direction, leaving the fingers extended straight out. It has worked wonders!!! If your husband has any movement or has regained his hand but just cabr move it due to muscle tightness PLEASE get this brace! If you have any questions you can find me on AIM at mxrider4524 or mxrider4524 at comcast dot net (if i placed it as a link it would not post this message) Look forward to heering from you and best of luck to your husband!
It's Not The Hand Your Dealt But How You Play Your Cards
Never Give up hope, Everything happens for a reason
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Postby HeidiP » Fri May 02, 2008 2:09 pm

Travis,
Thank you for the information. Ladd had a brace that sounds similar to yours, with the exception of the rubber band hooks. He continually works and messages his fingers. He can get them fairly limber, but they stiffen up again after a few minutes of inactivity.
He has actually been thinking about amputation lately. It will be 3 years since his injury next month, and he still needs to wear a sling most of the time as he doesn't have enough control of the arm to keep it from flopping around and potentially getting injured. He has not regained any feeling below the ebow and the movement he does have is not "functional" movement.
Amputation is particularly discouaging with all that he's been through to try to keep the arm; however, the doctors are sounding like they don't expect much (if any) further gain. I think they are disappointed as well because they really seemed to expect more significant results.
This was his second major wreck within a couple of years, and I think his body wasn't as able to heal and recover as it would have been without all of the previous trauma. He was a police officer and missses that kind of work terribly. It's been almost 6 years of on-going medical appointments and surgeries. He's wanting to move on and focus on something else. I don't know for sure what God has in store, but know that it is nothing short of a miracle that he is here today... with or without a right arm. In the big picture, we are truly blessed.
It is amazing to watch what he has learned to do with only his left arm. He just recently finished rewiring all new light fixtures in our house... by himself. It was quite something to see him balance the fixture on his head while he did the wiring with his left hand, then put it in place. He spent most of a year in a wheelchair, so it's amazing to see him standing on a ladder to begin with. God is good and really does give us everything we need. Sometimes I think that we just need to refocus on what are actual needs :wink:
Have a wonderful weekend!
Psalm 46:1 God is our refuge and strength, always ready to help in times of trouble.
HeidiP
 
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Heidi

Postby defaithed55 » Sun May 04, 2008 10:04 am

Hello:

I was reading the post /update on your husband, I feel like we're in the same boat. I too have hought about amputation, especiall because of all the pain I'm in. I just couldn't live with myself wondering what if I waited one more year........maybe my arm would have done something. I 'm rounding up to my 2 years aniversary of my injury, time really does go fast. I wish your husband the best of luck. I'm glad to hear how much he has adapted. I myself have overcome a great deal. I recently started fishing again. It's a bit tricky but mind over matter I guess. Well best of luck and keep us informed.

Carriann
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Postby betsy » Tue May 13, 2008 7:14 am

JAY T:
My son has a OBPI (from a birth injury). They did an EMG to find out how much nerve imput he has in his left arm. The testing can't tell you what nerves are ruptured and avulsed though. It only tells you what nerves they THINK are effected. It is not always accurate though.

[b]From what I've been told from Cincinnati's BP team, there is no way to tell if nerves are avulsed or ruptured. They have to go in and explore the area through surgery to find out and then just fix the nerves. [/b]

My son had nerve surgery done at 3 1/2 months old. He had one nerve torn from the spinal column that they rewired to a different nerve, and then a few nerves torn in the middle and they took grafts from both his legs and rewired them in the torn nerves. 2 1/2 months after the surgery we started seeing some movement. He has gained more and more, but we still have lots more to go.
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Postby mxrider4524 » Tue May 13, 2008 11:17 pm

Betsy,

Did your son get a test called a CT Milogram done? I had one done before my surgery around the same time as the EMG. They inject dye into the spinal fluid through a few small needles and then tilt the patient forward so the dye slides up towards the neck area. Then they take pictures that help determine what was damaged and so forth. It isnt the exact answer to what is riptured or avulsed but it was another step in the right direction. It helped my surgeon know to a point what he was getting into, although he still had to open me up to get a real idea what was damaged.
Travis
It's Not The Hand Your Dealt But How You Play Your Cards
Never Give up hope, Everything happens for a reason
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Postby betsy » Wed May 14, 2008 7:59 am

Hey Travis,
No they didn't do a CT Milogram. I've never even heard of it before. Maybe for infants it's a little too invasive. I'd imagine they would have had to put James Calvin to sleep to do it and with the risks of anesthesia and all... who knows. James Calvin got his EMG done at 2 months old. I'm gonna ask his specialists about it in July when I see them because I am curious. Was the test correct with what nerves had issues for you? Did it hurt? I'm not sure if I would've let my baby have the test done... the spinal fluid thing would freak me out!... I never had any drugs with my labor because the whole needle in my back thing scared me more than childbirth :lol:

I just read your story. Are you seeing anymore improvement? My son's docs said nerves heal slowly... like an inch per month. So I imagine that you have a total wait time of two years before you know how much movement you'll get back. James Calvin has 6-7 more months to go.
So what therapies are you doing? James Calvin has splints made for him. They sound similar to the ones you buy. He also makes a fist all the time and needs his night splint on to spread out his fingers and to hold his thumb to his hands side. He also, involuntarily, curls his wrist so his splints go from his fingers to his forearm as well.
Are you doing KINESIOTAPING? We just started that three weeks ago and are seeing improvement in his tension. He is so tight in his triceps and the tape is really helping relax them.
We are also doing ESTEM. HUGE improvement with that. Have you heard of it? It send electrical current (through electrodes) to muscle groups that we decide to have hooked up and it helps his muscles get strong with him having to move them. It's been three weeks since that and I'm already starting to see muscles form where he was limp before! It's been amazing. I think adults can do ESTEM as well. I like it because 1. it prevents atrophy and 2. when he does get more feeling and movement we'll be able to tell because he'll be able to move them and not be weak. I do it 2 times a day at home with him. Our insurance is fighting it, but we are gonna appeal. Until then it seems way worth the cost.
Okay, so I have a couple questions for you (hope you don't mind :D )
1. Does your arm hurt when the weather is about to change? James Calvin gets so fussy when it's gonna rain or snow and I'm wondering if it's his arm because normally he's really happy. And he's only 10 mos. so he can't tell me! Does the tingly feeling hurt? I know you said you can feel dull/sharp/tingely..
2. Has this injury really effected the things you love to do? Or are you able to compensate for your arm some other way? Do you find ways to get around the lack of using your injured arm? James Calvin is so young and I want him to play instruments and sports, etc, but I'm afraid this injury will hold him back so much. Even as a baby, he'll never be able to crawl, he can't hold toys with his left hand, he just hits them with his right, he just gets so frustrated cause he KNOWS he should be able to move around, but just can't! It's hard to see.
3. Are you a good candidate for the Triangular Tilt surgery? From the sound of your shoulder issue, it seems like the surgery may help. I know we are looking at the surgery in a few years for James Calvin. I guess your shoulders are held in place by muscles and joints and when you can't move them, it makes a bunch of imbalances and deforms your shoulder, so that's where the TT surgery comes in.

I know you are a young guy and it'd really suck to have to deal with this injury, especially because you've grown up with using BOTH arms. I'm 23 and feel like I've been dealing with this injury forever and I don't even have it!!! I've just been breathing Brachial Plexus for 10 months straight and it gets tiresome and frustrating. No one understands unless they are dealing with it personally. I hate when people say, "It's just his arm." I'm like, "NO! It affects way more than your arm too. Imagine not being able to use one of YOUR arms!" They have no idea the therapies, daily exercises, the surgeries... the waiting and not knowing, the other side effects of having a Brachial Plexus injury. All I know is that my son will grow up learning perseverance, strength, focus, determination, etc. And I know that you both will be strong even though y'all will have to deal with this all your lives. Sometimes it just doesn't seem fair though, does it?
Betsy
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CT Milogram

Postby defaithed55 » Wed May 14, 2008 2:04 pm

I have had this procedure twice. Although it is very uncomfortable, but like Travis said, it really can help pin point thr roots of the avulsion. When tipped downwards the fluids that was enjected wraps around the spinal cord and the branches/nerves that come from the spinal cord. in my case there was no fluid outline along the spinal cord where theC5.C6, AND C7 nerves would brach out. So the doctors knew where the damage was. This will be a good procedure to try because after you diagnose the problem you can take proper steps to help treat the problem. The best thing you can do is just try to be patient. Nerves take such a long time to grow. My nerve surgeries I think are just starting to attach themselves to where they need to be. I went for another EMG this past monday and got some positive results for the first time ever. I wish you all the best of luck, and keep me informed on all your progress.


Carrann
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