BY Dr. Mir Mohsin
In his hometown, Manzoor’s parents would long to see their child back home, only to find him in the field playing cricket long after finishing school. Manzoor loved the game and was keen to pursue it as a career.
Destiny had something else in store. He met withan accident and had multiple injuries to his robust structure including the one to his right axilla wherein the nerves were severed limiting his right arm movements, to a bare minimum. All bony and soft tissue injuries healed slowly but his nerve injury was left as such and he continued with limitation of movements in his right arm.
He could not hold a bat, not to talk about swirling it as he used to. Dejected he accepted the reality and lay back in his room with books rather than the bat in his hand.
Baby Ajalduring birth had an injury to the axilla resulting in a defect that was not detected till sometime after. Within a month of his being born, it was evident that his left arm had no movements and was listless compared to his right. As a child he had no complaints and his lack of movement in his left arm was a concern that battered his parents.
They went from one doc to another only to be assured but nothing concrete was done by anyone. Taking this as destined the poor parents stopped pursuing for more, had it not been for a good Samaritan who guided them to the right place.
Axilla is part of the arm that connects it to the chest, it is a pocket that hides much deep inside. Especially important is the confluence/network of nerves that arise in the cervical part of the spinal cord (roots),which get togetherbriefly in the neck(trunks) to divide again (divisions)before being distributed and getting dispersed to their respective areas of arm, hand, and chest.
This confluence of cervical and thoracic nerves is called the brachial plexuswhich is best protected from any injury by being deep inside the armpit. The nerves that come out of this plexus are named musculocutaneous, brachial, radial, ulnar, and axillary which supply the sensory and motor parts to the muscles of the arm for all the important functions. Any injury that results to this nerve plexus results in a peculiar weakness (palsy)- Erbs,Klumpke’s, and global being the commonest.
A brachial plexus injury occurs when these nerves are stretched, compressed, avulsed, or in the most serious cases, ripped apart or torn away from the spinal cord.
This typically isthe result of trauma to the neck, and upper arm and commonly occurs because of motorbike accidents, contact sports, difficult birth, trauma, and certain forms of radiation-induced injuries to the chest.
A minor injury can cause pain, weakness, and numbness in the arm and hand. Babies sometimes sustain brachial plexus injuries during birth. Rarely inflammation or tumors may affect the brachial plexus. Severe brachial plexus injuries usually result from automobile or motorcycle accidents.
Severe brachial plexus injuries can leave the arm paralyzed, but surgery may help restore function,ideally performed within the GOLDEN 3 MONTHSafter injury.
Given enough time, some brachial plexus injuries in both children and adults heal spontaneously with little or nolasting damage. But most injuries can cause temporary or permanent problems, like partial or complete arm paralysis, stiff joints, pain, numbness, muscular atrophy, or permanent disability. Severe injuries to the brachial plexus require early surgery, as they won't heal on their own. The timeframe for surgical repair is an important aspect of recovery, especially in cases of avulsion or rupture.If required, surgery should be done within three months ofinjury. The longer a muscle stays without nerve stimulation, the less is the chance that the muscle will function normally again which forms the basis of the GOLDEN 3 MONTHSconcept.
Brachial plexus reconstructive surgery uses microsurgical techniques to repair or replace damaged nerves,transfer functional muscles and tendons, and restore sensation and movement in the arm, elbow, wrist, and hand.Even after surgery, some people may experience residual muscle weakness or paralysis.
Manzoor was lucky to have a friend who recommended him to a specialist dealing with brachial plexus injuries. After a scrupulous assessment, multiple high-end surgical interventions were done to get the nerves back on track. After surgeries and meticulous physiotherapy Manzoor is back in the field weaving his lost passion in the best way he can. He is seen driving, pulling, and hitting the ball in all directions, a feat that was difficult just a few months back.
So is the case with Ajal who at age 4 months underwent microsurgery to his damaged nerves and in a few months was holding his favourite things and throwing them around. A new lease of life for him as well as his parents.
Awareness amongst the people about this injury and its possible management is lacking. Specialized surgical techniques (microsurgery) with specialized microscopic surgical instruments and importantly timely referral within the Golden 3 months is the key to the successful outcome of patients who have such types of injury. Such a facility is available within the valley now. SKIMS is the first and the only center in J&K and one of the only few Government hospitals in North India besides PGI Chandigarh, offering these services. It is an earnest request to those who read this article to spread the word in their neighbourhood and anyone suffering from such injury should come to the Department of Plastic Surgery for assessment and help that may be rendered if done in time.
Dr. Mir Mohsin, Additional Professor of Plastic Surgery, SKIMS, Soura, J&K. He can be reached at: m_mohsin@rediffmail.com
DISCLAIMER: The views and opinions expressed in this article are the personal opinions of the author.
The facts, analysis, assumptions and perspective appearing in the article do not reflect the views of GK.
