My Brachial Plexus Injury Story

  It has been 3 years after the surgery. I remember vividly the sensation on the way to the surgery room. The frustration of giving up hope for a full natural healing, and giving in to a calculated risk with estimated recovery level rates. My brachioradialis is still reminding me it was the right call. It is getting a bit stronger tho 💪. Everything related to the arm healing feels normal by now, and used to it by a long shot. Very grateful to Dr. Somsak and Dr. Kanchai for the fantastic work done on me. I continue my exercises as much as I can, and hopefully my self-discipline will help me to continue for at least a few more years.

So it has been 2 years and a half after the surgery. I continue to see significant improvements, traveling for the past few weeks I made good use of the arm pulling luggage, carrying stuff and of course, lots of eat and drink. It was cold in Scotland, but the hypersensitivity didn't bother too much. I see slight improvements on that side as well. In the place I stayed there was a lot of fire doors, kind of heavy. Most of the time I could use the arm to open them without much difficulty. As always, very happy with the result and continuing my daily arm exercise routines o/

Has been one year and a half since the surgery, and things continue to slowly improve. As usual, visual changes compared to 3 months ago are low profile. However, it doesn't feel that way at all. There's a very significant improvement of strength and usage of the affected arm, slowly making my right arm the dominant arm once again - at least for anything that doesn't require more than 90 degree elevation angle, then it needs some help. I barely keep track of new movements and "milestones" achieved nowadays, not as much because of wearing off from time consuming toil, but mostly because life as normal is mostly achieved at this point. Nevertheless, I still do keep my routine of recovery exercises. With the increased muscle mass in the deltoid, it's visual atrophy is less prominent and cracking noises are less frequent. Hypersensitivity of certain areas of the hand is improving. Mostly remaining in the thumb and lower part of the palm.

Recovery exercises and rehab are very important for this injury. You may quickly realize that it is not feasible to visit a physio every day - it would be challenging, both organizational and cost wise. During my days in occupational therapy, at the beginning of the injury, I noticed the environment and what could be expected of a continuous visit to that hospital (government sponsored). I tried a physio with alleged previous experience with BPI, and the prospect was not any better. On top of the mandatory nerve transfer exercises, I came up with a few series of exercises I've been doing since I was able to slightly move the arm. I don't know if these are the most optimal I could do, but I've heard that people doing physiotherapy on their own still can achieve decent recovery, so I thought I couldn't get too wrong on them. Before being able to trigger functional movement, I believe the most important is to send stimuli to the nerve. This is mainly achieved via the nerve

So 15 months have passed by... And feels great! Using the arm gets easier as time goes by.  Visually, doesn't seem to make a huge difference compared to 12 months mark. But I can feel quite a difference since.  A few weeks ago I started doing small planks, and I think I might be able to do one push up at some point. I started using my right arm to soap my hair and to brush my teeth, generally I try to make it the leading arm again. Some movements are easier than others, and most of them are not fluid yet.  To me, some of the key recovery points are achieving the movements needed to perform my hobbies. I'm a big fan of eating, so there goes one. Running, swimming and cycling are there too (although might not get on a road bike for some time, MTB or city bikes are good for now). The ultimate challenge will be riding my motorbike regularly again - or at least, have the choice to do it if I feel like it. Combined movements (flexion / abduction) are still a challenge and not very ac

It's been 1 year from my surgery. And I'm really happy with the progress. I'm back to running since the 10th month. That completes the last sport I used to practice (running, cycling and swimming).  I can eat with my right arm again. All the motions to turn the spoon and so on takes some adjusting, but the movement is there. After so long being a left-handed, it takes some "rewiring" to get used to do some things with the right arm again. Around this time, a measurement is done to find out the transfer efficiency (M2, M3, M4...). I am not sure which 'M' I have at this moment, but this is what I have: For some people, this could be seen as little. To me, this is great. After all the bad expectations I was put upon at the beginning, this feels like a second chance to have a full movement life. This might not be the final result. I've shared my progress with my physicians and they believe I could improve further - if I stick to my current rehab exercises

Oberlin transfer is commonly used to restore elbow flexion. Single or double fascicle can make a difference for you, but from a medical point of view, surprisingly it doesn't. The medical objective is to reach M3, which can be accomplished by just a single transfer from the ulnar nerve to the biceps. Pros are basically a lesser chance of side effects of a nerve transfer happening, like accidentally damaging the nerve or residual weakness in the hand. Cons are, basically, less strength on your elbow flexion. A double fascicle transfer will additionally innervate the brachiallis from the median nerve. Arm movement might be similar to single fascicle transfer (or that's the general believe), but about half of the elbow flexion's strength comes from this muscle according to physicians. To you, his means you might not be able to pull up that box of milk anymore when carrying groceries - although this is just an speculation from my side. A double transfer will be more expensive,

I ruptured my C5 and C6 nerves - from what I have been told, these are the usual nerves affected in motorcycle accidents. C7 was initially damaged as the MRI reported, but luckily it was just a pull and quickly recovered. My C5 is supposed to be post ganglionic, but the supraspinatus nerve was affected as well. I lost elbow flexion and arm abduction. This is, I couldn't move the arm but I could move my wrist and fingers. Sensation, however not as before, remained in the respective areas. Some doctors believe some fibers survived hence I conserved sensitivity, others mentioned sensory nerves can sometimes be innervated by different nerves. Pain wise, it was excruciating. C7 nerve pain while reconnecting wouldn't let me sleep. C6 sensory area was like having your skin on fire. This lasted for about 2 months, then the pain was more manageable. MRI done 1.5 months after the accident was very clear about the damage. Electromyography and nerve conduction studies performed 1 and 2 mon

Reaching the 9th month life quality gets improved a lot. Elbow flexion is pretty good at this point. I was able to do 5 KG weights easily for biceps, and 3 KG weights for brachiallis. Arm abduction was not close to M3, but a good range of motion was achieved. A slight increase in muscle density could be felt in the deltoid. By the 8th month I started cycling again. Not on a road bike like before, but on a comfortable, stable and more upright city bike. Swimming became an everyday thing for me since the 7th month. I believe it helps with the recovery, since in the water you can easily move the arm it is more practical to get the muscles going. I developed a set of exercises that will be shared in a separate post. Long walks of more than 10 KM with minimal arm support were comfortable. The affected arm becomes of use for the day to day. At that time I opened doors with it, carried light objects, used it to get dressed etc. I was occasionally able to snack and reposition my specs with it.

A few months after the surgery is when good things will start to happen. So slowly that will be difficult to appreciate, but they are happening. From this moment onward, you will start to notice that some of your atrophied muscles are slowly becoming less bony. This doesn't mean that the muscle is back at this point, but just a tiny bit. Nerve pain might be still at its peak. This could last for a while. Around this time you will start to observe small contractions when activating the innervating nerves for the elbow flexion. For example, with Oberlin transfer, making a fist will cause some feeling around the biceps. Those sensations will soon become small but visible contractions. From there, you will observe small movements but don't expect any anti gravitational force on elbow flexion anytime before 4 months after the surgery. Depending on what transfer was done for your supraspinatus, it is possible that you will observe changes there a few weeks or months after this point.

You will notice changes in your body. Both before, and after the surgery. Of course, it all depends on what kind of injury you have - what nerves are affected and how. For similar injuries to mine (c5 c6 rupture), this is what I noticed for the first 3 months. First, you will start to notice occasional cracking in the shoulder when there's some induced movement (i.e. when you are using your other arm to position the affected limb in a comfortable position). This is your deltoid getting atrophied and not holding your arm as it should. This will start a few weeks after the accident, and depending on your muscle mass it could be noticeable for 2 to 3 weeks. After that you might occasionally still notice it, but the arm is loose enough to be mostly out of its original position. Eventually you will notice there's almost no deltoid left. For me it was after 2 months or so, but it depends on how muscular you were before the accident (I wasn't). If a muscle doesn't receive nerv

For some time, the main source of pain might be neuropathy. Unfortunately, I have endured a good deal of nerve pain. It is not always the case from what I've read. One year later, I do still have occasional moments of intense pain, but nothing compared to those first months. The doctors prescribe Gabapentin for this. It rarely worked for me, but actually doesn't work for many people. However, I learned a few things along the way that really helped me manage the pain. A note on this, in avulsion cases there's something called 'phantom limb' pain, which probably doesn't relate to what I experienced. There might be a moment when sensitivity nerves start to repair themselves, causing a miss adjustment on how things are usually felt on the skin touch - a mild wind flow could be felt like a cat scratch. For hypersensitive sensation on the skin, I found warmth helped greatly. Hot showers helped to calm down certain areas, but make sure you have the softest towel to dry

The two best words that can describe my first weeks of injury: confusion and pain. I don't know if this is just coming across the wrong people. After crossing the border with Malaysia, I went straight to the General Practitioner who sent me right away to hospital emergencies. They started their tests. One of the male nurses (or doctors, I can't remember) was asking me questions about the accident, and he mentioned I might need some micro surgery. Right away he checked for my sensitivity on the C5 and C6 sensory areas. He explained to me I had a brachial plexus injury, and that I could google it to get more details (seriously). He gave me meds and set up an appointment to see a hand specialist a few weeks later. He gave me a specific medication for the arm pain. I mentioned I did't have any pain in the arm. You will - he predicted. Then I was on my way home. Fuck yes I had pain the next day. It was like someone was stabbing me with an electrified knife all around the arm. At