nervetrauma

Deciding whether or not to undergo exploratory surgery on your damaged nerve may well be one of the most difficult decisions of a lifetime. In a nutshell, the pros and cons of choosing surgery soon after your injury:

Pro:
- If your nerve is torn, it can be surgically repaired
- If it’s not torn, at least you’ll have a better idea of the situation
- If you decide on a conservative approach, you may find that you wasted valuable time if surgery is needed later; or, worst case scenario, surgery may not be as successful

Con:
- If the nerve is not torn, surgery cannot do a blessed thing to help it
- Risk of infection
- Risk of damage to muscle, other nerves, tendons etc
- Painful and inconvenient
- Missing out on work and activities because of recovery time

The accepted wisdom seems to be that nerve regeneration can spontaneously occur between 3-6 months. If one waits that period of time and then undergoes surgery, the success of surgery is not usually compromised. Radial nerves especially have a high rate of spontaneous regeneration. Therefore, it makes sense to me to wait 6 months before considering surgery. I’m currently on the third month and have seen no improvement in my mobility. If I didn’t have these numbers and facts in front of me, I’d probably be feeling pretty discouraged.

Traumatic Nerve Injuries - An Overview
“The usually timing of surgery is 3 to 6 months for “uncertain” injuries. If you wait longer than one year, then the chances of recovery are minimized.”

Closed Fractures Complicated by Peripheral Nerve Injury
“Patients who fail to demonstrate signs of recovery at 6 months, either clinically or with electrodiagnostic testing, should undergo exploration to maximize the likelihood for return of function.”

Neuropathy Message Board
Some very reassuring personal anecdotes here!

Radial nerve palsy associated with fractures of the shaft of the humerus
“The overall rate of recovery was 88.1% (921 of 1045), with spontaneous recovery reaching 70.7% (411 of 581) in patients treated conservatively. There was no significant difference in the final results when comparing groups which were initially managed expectantly with those explored early, suggesting that the initial expectant treatment did not affect the extent of nerve recovery adversely and would avoid many unnecessary operations.”

Here’s an interesting study which looked at the feasibility of using ultrasonography (US) to evaluate nerve injuries. The study focuses on radial nerve injuries, but I imagine that the results are equally relevant to other types of nerves. It’s a small study, but the consistency between the US findings and the specifics of each patient’s case is reassuring.

“In five patients, US findings of a severely damaged radial nerve were confirmed at surgical nerve inspection. In one patient, the nerve was entrapped between fragments. One patient had a complete nerve dissection, one had a lacerated nerve from a loose compression plate, and one had a nerve riding on the edge of a bone fragment. In the fifth patient who underwent surgical inspection, the nerve was buried in the callus. In the six patients treated conservatively, US showed continuity of the nerve.”

The study concludes that US “may be useful for accurate evaluation of the radial nerve in patients with nerve palsy associated with humeral shaft fracture.”

And here’s the link:

http://radiology.rsnajnls.org/cgi/content/full/219/3/811

If your doctor doesn’t suggest an ultrasound, it’s worth asking for one. My ultrasound didn’t show that the nerve WASN’T torn–but it didn’t show that it WAS, either! I have a hunch that if the nerve is really badly damaged, it will show up on the ultrasound, and that could save you months of agonizing and waiting before making the decision to have surgery.

Some studies have shown that acupuncture can encourage nerve regeneration. Since the studies are not conclusive either way, how can you decide whether you want to try acupuncture as part of your treatment? Let’s look at a few studies before delving into that question….

This study is promising, but is based on a single case: http://www.liebertonline.com/doi/abs/10.1089/acm.2005.11.167

This one is a little more in depth: http://findarticles.com/p/articles/mi_m0HKP/is_2001_Summer-Fall/ai_81596687/pg_4?tag=artBody;col1

An exercpt: “After 6 weeks of recovery, we found that the regenerated nerves in both the groups of acupuncture and electroneedling had highly vascularized cross sections in which myelinated axons were numerous in the endoneurial areas.” Yes, this is a GOOD thing! The control group in this study did not do as well. Keep in mind that they were using animals and that we don’t know how many animals were in each group. The larger the cases in a study, the more reliable the results.

And here’s a nice succinct abstract:http://www.ncbi.nlm.nih.gov/pubmed/7650958

Now…some things to keep in mind as you explore treatment options.

1. Acupuncture has been practiced for thousands of years and is widely accepted in many countries, although most health care plans in the USA do not cover it.
2. Because acupuncture practice is not regulated in the same way as medical practice, it’s wise to be even more choosy and get a personal referral, if possible–don’t go to someone who’s been practicing only a few years.
3. If you are committed to your healing, you will want to explore every single possibility. It’s very unlikely acupuncture could hurt you. If you’re nervous about it, ask other people about their experiences.

I had my first experience with acupuncture on November 4. As someone who is terrified of needles, I can testify that it was an anti-climactically unscary experience. My arm felt warm and tingly, not painful at all. I plan on going twice a week. Although my insurance won’t cover this, I can add the cost to my personal injury claim. Also, I’m using a clinic built on a community model, where patients share treatment space and the practitioner can see several at a time. It keeps costs low, and it’s a pleasant atmosphere.

As anyone who’s ever had a nerve injury knows, nerves can be maddeningly slow to heal. The most frustrating aspect of the long road to healing is that oftentimes it’s impossible to pinpoint the exact nature of the damage or to predict a date of full recovery.

On August 5, 2008, a careless driver failed to yield to me in a crosswalk and slammed into me, throwing me 15 feet in the air. I landed on my left arm and immediately felt a sharp pain–my humerus (upper arm bone) had broken. I also felt a tell-tale numbness in my forearm; the radial nerve, which wraps around the humerus, had been either torn or stretched. Since that unfortunate incident, my left hand hangs limply (”drop-wrist”) and I’m unable to extend my fingers.

In the course of my personal quest to learn as much as possible about the nature of my injury, I became increasingly aware of the lack of consolidated information available online. I decided to start this blog in order to provide reliable information, encourage discussion, and inspire hope in all of us who are looking for answers and support. Topics will include current medical research, conventional & alternative treatments, case studies, and advice on where to do your own research and who to trust when planning your treatment.

Thank you for visiting, and please feel free to post comments about your own experience, or request research on a specific topic.