Recent lesion of the radial nerve and paralysis of the brachial plexus
March 4, 2011 | 30,00 EUR | answered by Uni-Arzt Freddy Feuerstein
My daughter (18) had a riding accident about 20 months ago with the above-mentioned injuries. The radial nerve injury occurred due to a fracture of the upper arm, which was treated with a nail. The initial assessment by a neurologist was as follows: complete lesion of the left radial nerve in the context of a fracture of the upper arm shaft, affecting all muscles including the brachioradialis muscle, the triceps brachii muscle is not affected. Additionally, there is an upper left arm plexus palsy with complete motor deficits, absent sensory disturbances, and reflex deficits.
The latest measurement report from December 2010 reads: left radial nerve motor with significantly slowed nerve conduction velocity and greatly reduced amplitude, left radial nerve superficial branch not measurable, EMG of the biceps brachii muscle, brachioradialis muscle, and extensor digitorum muscle showing pathological spontaneous activity and signs of reinnervation. EMG of the left dorsal interosseous muscle is normal except for some polyphasic potentials.
Our daughter complains of weakness in her left arm, occasional pain in her left shoulder, and sensory disturbances in the area of her left thumb. According to the treating neurologist, a full recovery can be expected within the next few months. My question now is, do you share this assessment? Can nerves still recover after such a long time? Does this also apply to the currently unmeasurable ones?
Thank you for your efforts.
Kind regards.
Dear Inquirer,
first of all, a note on the natural process.
1. Traumatic degeneration occurs at the site where the nerve is injured. The nerve ending (axon) disintegrates, and the growth cone begins to swell.
2. Descending degeneration occurs, meaning the nerves deteriorate distally (away from the body). (The so-called Wallerian degeneration).
3. This is followed by retrograde degeneration, which goes proximally into the spinal cord.
4. Now the REGENERATION begins. The nerve starts to grow again and roughly speaking grows back to the end organ (e.g. muscle) and to the connection to the spinal cord.
Nerves ideally grow at a rate of 1-2 mm/day, so theoretically after 20 months at 30mm, continuity should be restored. Even taking less optimistic studies that speak of 2-4 mm per week, continuity of the nerves should have been restored after 20 months.
Was one of the affected nerves severed back then? If so, was it reattached?
Pain and sensory disturbances may still occur even after complete nerve regeneration. The original state will never be reached again. It will always feel different in the affected areas compared to the healthy side. However, the body learns to cope with it. In your daughter's case, there seems to be a greater impairment, so it is important to "stay on top of it."
Regarding the assessment and your actual question,
theoretically, even after such a long time, regeneration can still occur,
practically, it is impossible to estimate when and if it will occur at all.
One can only wish from the bottom of their heart that your daughter's condition continues to improve.
If you have any further questions, please feel free to ask,
otherwise, I wish you a lovely week and your daughter a good healing process.
Best regards,
T.C. Müller
