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.