Preventing nerve damage after an accident

Preventing nerve damage after an accident

Maria Endah Hulupi, The Jakarta Post, Jakarta

While injuries from traffic accidents, especially those from
motorcyclists, are an everyday occurrence on Jakarta streets, few
victims seek help from a specialist in nerve injury treatment.

Some people are simply ignorant about the importance of the
treatment; for others, it may be a concern about the cost.
But if such a nerve injury is left untreated, the people may
suffer permanent injury, such as to the arms, elbows or shoulder,
neurosurgeon Daniel Kim warned.

"Very often a patient comes to the doctor, holding his arm
because he has no arm movement," said the director of the
neurosurgical department of Stanford University in the U.S. in a
recent seminar on brain and spine management, organized by Pantai
Indah Kapuk Hospital in North Jakarta.

The brachial plexus is a complex network of nerves,
controlling movements of the chest, shoulders and arms. It is
often damaged when traffic-accident victims injure the lower part
of the shoulder.

When treating a patient with brachial plexus injury, doctors
must understand the anatomy of the nerve system when conducting
the examination. Following examination, the doctors need to
quickly assess the level of injury and what nerves have been
involved.

"It is not just a brachial plexus injury, because there are
different elements and components of a brachial plexus," Kim
said.

Most brachial plexus injuries in this country are due to
street accidents. But Kim added that such injuries can also be
caused by knife and gunshot wounds, and can also occur during the
delivery process, when an obstetrician grabs the baby by its
shoulder or arms to pull it out of the mother's womb, causing a
stretch injury, called brachial plexus palsy.

It can also be a side effect of radiation therapy, especially
for breast and lung cancer treatments.

"In Indonesia, people with brachial plexus injuries,
especially those caused by street accidents, are referred to an
orthopedist ... but not to a neurosurgeon," Alfred Soetrisno, a
neurosurgeon with the hospital, said on the sidelines of the
seminar.

The hospital's senior director, Satyanegara, also explained
that most patients do not receive proper treatment because the
treatment is complicated and many hospitals still lack the
equipment required to ensure good results.

"It depends on the injury... but when the injured receives
proper and timely treatment, his or her chance to recover is
good," he said.

In the United States, Kim said, surgical treatment for
brachial plexus injuries is performed by a neurosurgeon.

He performed a cadaver dissection at the seminar to identify
the location of the nerves, which he started by making a z-shaped
incision on the upper right shoulder.

Kim said that the severed nerve can be reconnected by making a
nerve graft repair, using the sural nerve from the leg area.
"This is very common and after the surgery, the patient will walk
just fine."

Another option is to take a nerve graft from the arm area.

"We don't recommend neurosurgeons take motoneurons since
they're will paralyze certain parts of the arm. So (it is
advisable to) take cutaneous nerve," he said.

While some brachial plexus injuries do not need treatment as
they will heal on their own, Kim also stressed the importance of
timely treatment.

"If the injury is one year old or older, the chance for
recovery is very small since the muscles become atrophied and
there will be very little functional recovery that can occur," he
said.

After the surgery, Kim recommended physical therapy begin as
early as possible.

"Even (the therapy should start) within the first week after
surgery, because when a patient has paralysis in his arm and he
doesn't move it, he will develop a frozen shoulder and elbow. His
tendon becomes contracted so he will develop a tendon
contracture."

He also advised patients to regularly open their fingers and
exercise them so they do not develop a "claw", or rigid, hand.

Success of the recovery depends on the age of the patient and
the nerves involved.

Kim explained that the nerves of children regenerate faster
than those of adults. Also, some nerves in the deltoid, triceps
and biceps recover faster than those of finger muscles, for
example.

"Based on our experience, the recovery could take as long as
two to five years," he said.