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As nerves exit the spinal cord and enter the arm, they form what is called the brachial plexus.

"This collection of nerves powers the entire arm and hand, so it provides all of the motor function to the arm and hand, and all the capabilities of the arm and hand are powered by the brachial plexus," says Dr. Noland.

Damage to these nerves needs to be cared for in a timely manner to avoid problems. Dr. Noland says if too much time has passed, then the options become more limited for repair and reconstruction.

Treatment options

The most common surgical options are nerve reconstruction, nerve repair, nerve grafting and nerve transfers.

"We treat brachial plexus injuries primarily through the use of what's called a nerve transfer. And a nerve transfer can be thought of as rewiring the injured nerves with good nerves that are nearby and functioning, but also expendable," says Dr. Noland.

Postoperative rehabilitation or physical therapy are crucial to healing.

"That includes what I like to think of as rewiring the brain and training the brain for the new function. So essentially training one nerve to perform the function of another nerve," she says.

Read more:

• "Treatment strikes a chord with patient after life-altering accident."

The post Mayo Clinic Minute: Surgical options to treat brachial plexus injuries appeared first on Mayo Clinic News Network.

Editors Note: This story was originally published in Mayo Clinic Magazine.

A first responder pronounced Maurice Orange dead. Maurice's body lay crumpled on the hot asphalt in San Diego. His prized Gold Wing 1800 motorcycle wrecked nearby.

His fiancée, Cheri, knew something was wrong that afternoon — Aug. 14, 2020. She got a call that Maurice hadn't shown up for work his usual two hours early at the martial arts studio he owns.

Then, her heart sank further. She heard there had been an accident involving a motorcycle near the couple's home.

"I just knew," Cheri recalls.

The following details were a blur.

Maurice was reassessed at the scene and determined to be alive. He lost a lot of blood. He had a collapsed lung, a fractured pelvis and broken ribs. His carotid and vertebral arteries were severely damaged. He had brain swelling, a subarterial hemorrhage and deep lacerations on his chin, upper lip and more. His left arm sustained significant damage — a broken wrist and dislocated elbow.

The only glimmer of hope? Maurice's pupils were responsive.

Cheri seized it.

“I hung onto that positive sign like a thread for the rest of the journey,” she says.

Fight or Flight

Maurice, a Navy veteran, is a taekwondo grandmaster who has been practicing since age 10. He relishes physical tests. The next year would prove to be the most challenging one he’s ever experienced.

Five days after the accident, Maurice was stable enough to undergo the first of several surgeries. One inserted two rods in his pelvis. Another, two plates in his left forearm. A third reconstructed his left wrist.

Two weeks after the accident, he could open his eyes, follow commands and make small, intentional movements — wiggling his fingers and toes and giving a thumbs up with his right hand.

Maurice transferred to a long-term acute rehabilitation center to continue his treatment. Surgeons placed a hole in his neck to access his windpipe to help him breathe with a ventilator. Maurice also wore neck and back braces. He made slow, steady physical progress but was struggling mentally. Due to the COVID-19 pandemic, Cheri was not allowed to visit him.

“I didn’t know who I was, where I was or why I was there,” says Maurice. “I didn’t remember anything about the accident. Being a martial artist for most of my life, I was in a fight or flight mentality. I felt the need to protect myself from the masked strangers — nurses — continually coming up to me, poking me and speaking three different languages.”

Making Progress

By mid-October 2020, Maurice was breathing on his own. He transferred to a skilled nursing facility for his substantial rehabilitation needs. This time, Cheri was able to visit him through a window. By November, Maurice could walk up to 10 painful steps at a time with a cane.

Finally, in December, Maurice returned home for the first time in over three months. He needed a wheelchair and 24-hour care, but he was glad to be home.

On Dec. 14, he and Cheri got married in a small ceremony. By February, Maurice sat in on classes at the martial arts studio, high-fiving and coaching the students and their parents. He was eager to be back in his element.

Journey to Mayo Clinic

But something still wasn't right. Maurice’s left hand and arm had gotten infected in the hospital and still hung limp at his side. His fingers were swollen and locked, and his elbow was still dislocated.

The crash damaged a network of nerves that send signals from the spinal cord to the shoulder, arm and hand. This damaged network, known as the brachial plexus, can leave the arm paralyzed.

His local doctor realized Maurice's injury wasn’t getting better. She reached out to Alexander Y. Shin, M.D., a hand surgeon at Mayo Clinic, for a consultation.

In February 2021, the Oranges traveled to Mayo Clinic in Rochester, Minnesota. They met with Dr. Shin and a group of experts who had assembled to work on Maurice's case. The team included physiatrist Keith A. Bengtson, M.D., orthopedic surgeons Mark E. Morrey, M.D., and Allen T. Bishop, M.D., and neurosurgeon Robert J. Spinner, M.D.

Maurice's care team consulted with the Oranges, and together they determined amputating his infected forearm would be the best option. The team would also relocate his elbow.

“Cheri and I prayed about it. She would cry a while, and I would cry a while," says Maurice. "At the end of the day, my left hand had little to no use. We decided that amputation was the right thing to do.”

Becoming Whole

Dr. Shin explained to the Oranges that Maurice’s hand would never function exactly like it did before the accident. Luckily, Maurice is right-handed, so Dr. Shin’s goal was to equip him with the best possible “helper hand” in the form of a prosthetic.

“He said to us, ‘Sometimes to become whole, we have to take you apart first,’” says Cheri.

Maurice went into surgery on March 3, 2021. The procedures, which lasted about 11 hours, went well. He had one more elbow surgery a few days later, and then they were able to return home.

Maurice and Cheri say they were in awe of the open, honest, kind, professional care they received from everyone at Mayo Clinic.

“I have never seen medical professionals conduct themselves like the professionals at Mayo Clinic,” says Maurice. “It was a humbling feeling to be treated with such respect and such care.”

Upon return to San Diego, Maurice completed a full-time rehabilitation program. In September 2021, the Oranges traveled back to Mayo Clinic so Maurice could be fitted for a prosthetic hand at an independent prosthetic laboratory. 

When Maurice learned that his new hand could be made to match his right hand — skin color, hair, fingernails and all — he said, “Absolutely not.”

“I wanted my new hand exactly the way it comes out of the box,” he says. “My plan is to be known as the bionic grandmaster.”

With his helper hand, he continues to get even closer to normalcy. He intends to practice martial arts again and has already hosted friends, grilling steaks for them.

"I have never seen medical professionals conduct themselves like the professionals at Mayo Clinic. It was a humbling feeling to be treated with such respect and care."

MAURICE ORANGE

"With my prosthetic, for the first time since my injury, I’m able to cut my own steak.”  

The post Sharing Mayo Clinic: Taekwondo Talent Finds Second Chance at Mayo Clinic appeared first on Mayo Clinic News Network.

ANSWER: Brachial plexus injuries involve damage to the network of nerves that sends signals from your spinal cord to your shoulder, arm and hand. These injuries often cause weakness or paralysis, as well as numbness in the hand, arm or shoulder, and they can be very painful. The goal of treatment for a brachial plexus injury is to restore as much function as possible. When the injuries are minor, surgery may not be needed. But in a case like yours, where the brachial plexus is torn, surgery often is required.

Your brachial plexus includes five major nerves that originate at your spinal cord and travel down through your shoulder to your arm and hand. Those nerves control all the sensation and motor function in your entire arm.

Brachial plexus injuries usually occur when your head and neck go one direction and your shoulder is forced in the opposite direction. Less severe forms of this injury can happen during contact sports, such as football and wrestling. More severe injuries to the brachial plexus often happen due to trauma sustained during high-speed motor vehicle crashes.

Symptoms depend on the severity of a brachial plexus injury. They may include a burning sensation down the arm, weakness, numbness and inability to use certain muscles. If a brachial plexus nerve is pulled out of the spinal cord at its root — a condition known as avulsion — it can lead to a complete inability to move or feel anything in the arm, shoulder or hand controlled by that nerve. Many brachial plexus injuries also cause moderate to severe pain.

Fixing an injured brachial plexus involves repairing the nerve damage. The way that’s done depends on the type of injury you have. If a brachial plexus nerve is compressed or slightly stretched, it may not need treatment. But physical therapy may be appropriate to keep joints from becoming stiff while the nerve heals.

When the nerves stretch to the point that some of the nerve fibers come apart, a nerve tears into separate pieces, or the nerve is pulled from the spinal cord, then surgery is necessary to repair the damage. If a brachial plexus nerve is damaged somewhere other than its root, the surgery involves removing the damaged portion and replacing it with a section of a nerve taken from another part of your body. This is called nerve grafting.

When a nerve is completely ripped from the spinal cord and no nerve fibers remain behind, there is no way at this time to surgically repair the damage. But treatment is available to help restore function. That may involve transferring functioning but less important nerves to the injured nerves that have a more important function. This type of surgery is called a nerve transfer. A more complex procedure entails moving a muscle from your leg to your injured arm using microsurgery to potentially restore more function.

It’s generally recommended that brachial plexus surgery takes place within about six months from the time of the injury. Surgeries that occur after that typically have lower success rates.

It’s also best to seek treatment at a health care facility that has a multidisciplinary team available to treat brachial plexus injuries. At Mayo Clinic, for example, a team that includes a neurosurgeon, orthopedic surgeons, hand and microvascular surgeons, physical rehabilitation experts and other specialists, as needed, collaborate to evaluate and treat people with brachial plexus injuries. — Dr. Alexander Shin, Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota

The post Mayo Clinic Q and A: Treatment for brachial plexus injuries involves repairing nerve damage appeared first on Mayo Clinic News Network.

Treatment for a brachial plexus injury depends on several factors, including the type and severity of the injury, the length of time since the injury, and other existing conditions. Nerves that have only been stretched may recover without further treatment; whereas, other injuries may require physical therapy. The most severe injuries can require nerve graft or nerve transfer surgery.

On the next Mayo Clinic Radio program, Dr. Alexander Shin, an orthopedic surgeon at Mayo Clinic, will discuss diagnosis and treatment of brachial plexus injuries. Dr. Shin also will talk about carpal tunnel syndrome. Also on the program, Dr. Naima Covassin, a cardiovascular disease researcher at Mayo Clinic, will share the findings of a recent Mayo Clinic study showing how eating breakfast regularly can help control weight gain. And Dr. Heather Fields, an internal medicine specialist at Mayo Clinic, will explain the dangers of eating too much red meat.

To hear the program, find an affiliate in your area.

Use the hashtag #MayoClinicRadio, and tweet your questions.

Mayo Clinic Radio is on iHeartRadio.

Access archived shows or subscribe to the podcast.

Mayo Clinic Radio produces a weekly one-hour radio program highlighting health and medical information from Mayo Clinic.

The post Mayo Clinic Radio: Brachial plexus injury appeared first on Mayo Clinic News Network.

Treatment for a brachial plexus injury depends on several factors, including the type and severity of the injury, the length of time since the injury, and other existing conditions. Nerves that have only been stretched may recover without further treatment; whereas, other injuries may require physical therapy. The most severe injuries can require nerve graft or nerve transfer surgery.

On the next Mayo Clinic Radio program, Dr. Alexander Shin, an orthopedic surgeon at Mayo Clinic, will discuss diagnosis and treatment of brachial plexus injuries. Dr. Shin also will talk about carpal tunnel syndrome. Also on the program, Dr. Naima Covassin, a cardiovascular disease researcher at Mayo Clinic, will share the findings of a recent Mayo Clinic study showing how eating breakfast regularly can help control weight gain. And Dr. Heather Fields, an internal medicine specialist at Mayo Clinic, will explain the dangers of eating too much red meat.

To hear the program, find an affiliate in your area.

Miss the show?  Here's your Mayo Clinic Radio podcast.

Use the hashtag #MayoClinicRadio, and tweet your questions.

Mayo Clinic Radio is on iHeartRadio.

Access archived shows or subscribe to the podcast.

Mayo Clinic Radio produces a weekly one-hour radio program highlighting health and medical information from Mayo Clinic.

The post Mayo Clinic Radio: Brachial plexus injury / carpal tunnel syndrome / importance of eating breakfast / dangers of too much red meat appeared first on Mayo Clinic News Network.

This article first appeared In the Loop September 17, 2015

Troy Chroniger of Orlando, Florida, enjoyed a busy, if hectic, life as a construction estimator and dad to three daughters. To relax, Troy, age 43, enjoyed sports and an occasional motorcycle ride with friends. Life changed dramatically one Saturday in November 2011, when he was out for a ride, hit a rough patch of road, veered and collided with a guardrail. He was rushed to a hospital in Orlando, where doctors diagnosed him with a debilitating brachial plexus injury.

“It was one of the worst the doctor said he’d seen,” Troy recalls the physician saying. Of the five nerves that make up the brachial plexus in the shoulder, Troy suffered a complete nerve evulsion injury. His doctor referred him to Mayo Clinic, which performs hundreds of brachial plexus procedures annually. At Mayo, Troy visited Peter Murray, M.D., Orthopedic Surgery/Neurologic Surgery, who specializes in the delicate and complex procedures required for nerve injuries and the accompanying loss of function that can occur after an injury such as Troy's."   Click to read the rest of Troy's story.

The post In the Loop: Delicate Nerve Procedure Helps Troy Get his Mobility Back appeared first on Mayo Clinic News Network.