ATLANTA, GA ( Ivanhoe Newswire) - They can happen during birth or a bad fall. Brachial plexus injuries occur when the head and shoulder are pushed in opposite directions and can cost kids the use of their arms. Now, with some assistance from the dead, doctors are helping children with severe forms of the injury.
"I tried to move it around and i couldn't move it at all. It was like my whole arm wasn't working," eight-year-old Jake Griffin told Ivanhoe.
When Jake hurt his arm in a fall, he figured it would get better in a week or two.
"He couldn't move his arm for about six months, it just kind of hung there," Stephanie Griffin, Jake's mom, said.
Jake suffered a brachial plexus injury. It stretched and even tore nerves that control his right arm
"Depending on the number of nerves injured sometimes they lose shoulder elbow function, sometimes they lose everything," Allan Peljovich, M.D., medical director of pediatric hand & upper extremity program/ brachial plexus program at Children's Healthcare of Atlanta, said.
Traditional surgery for these injuries used a nerve graft from the patient's own leg to make the repair. Doctors at Children's Healthcare of Atlanta are doing something different.
After identifying the severed nerves, surgeons use custom-fit nerve grafts from cadavers. Gluing in the donated fibers to bridge, or even reroute the broken connections.
"There can be a perfectly size matched graft placed quickly and easily, relatively effortlessly which provides us we think with every advantage that the traditional nerve graft did," Joshua Ratner, M.D., director of brachial plexus program at children's Healthcare of Atlanta, said.
Thanks to some help from beyond the grave, ten months after surgery, Jake's strumming away on his guitar.
"Oh it's huge, and I still have deep hope in my heart that he's going to completely get better," Stephanie said.
Jake still has a lot more therapy ahead of him. The hope is he will get back more strength and mobility. Meanwhile, the doctors who pioneered his procedure believe that using donor nerve grafts could eventually become the standard of care for treating children with these injuries.
BACKGROUND: The brachial plexus consists of a network of nerves that originate near the neck and shoulder. These nerves begin at the spinal cord in the neck and are responsible for control of the hand, wrist, elbow, and shoulder. The brachial plexus includes nerves that are both motor and sensory. When an Injury occurs to a nerve it can stop signals to and from the brain, preventing the muscles of the arm and hand from working properly, and causing loss of feeling in the area supplied by the injured nerve. When a nerve is cut, both the nerve and the insulation become severed. Pressure or stretching injuries can cause the fibers that carry the information to break and stop the nerve from working. Some brachial plexus injuries are minor and will recover in a few weeks, other injuries can lead to a more permanent disability. (Source:http://www.assh.org)
INJURY SYMPTOMS: Those with brachial plexus injuries will experience problems with sensation and lack of muscle control in the hand, arm and shoulder area. Generally, symptoms include pain, numbness, and difficulty moving. "Depending on the amount of nerves that are injured sometimes they lose shoulder/elbow function, sometimes they lose everything," Allan Peljovich, Medical Director of Pediatric Hand & Upper Extremity Program, Brachial Plexus Program at Children's Healthcare of Atlanta said. (Source: www.bettermedicine.com)
CAUSES: The network of nerves is fragile and can be damaged by pressure, stretching, or cutting. If the head and neck are forced opposite of the shoulder stretching can occur. If severe enough, the nerves can actually tear out of their roots in the neck. Brachial plexus injuries can occur from a variety of causes including difficultly during child birth, while playing sports, or from motorcycle accidents. (Source: www.assh.org)
NEW TREATMENT: Many brachial plexus injuries can recover with time and therapy depending on the severity of the injury. However, when an injury is unlikely to improve, several surgical techniques can be used to improve the recovery. In some cases, surgical repair of the nerves or transfer of undamaged nerves can be performed. Traditional surgery for brachial injuries consisted of using a graft from the patient's own body. Doctors are now able to use nerve grafts from cadavers that custom fit to the patients' damaged nerves. "In terms of time savings and the fact that you can really get good nerve match for the defects that we're treating, if this proves to be as effective as traditional donor nerve, which so far its seems to be, then I think I will likely replace much of the donor nerves that we use today," Dr. Pelvich said.
Doctors feel this is a great advancement from the traditional surgery because of the ease and smoothness of the surgery. (Source: www.ubpn.org)
Dr. Allan Peljovich, Medical Director of Pediatric Hand & Upper Extremity Program, Brachial Plexus Program at Children's Healthcare of Atlanta, talks about how doctors are going to to the grave to help kids.
So with these kids who are born with this injury or I guess it can happen with trauma too, when they have this kind of stretchy thing like when their nerves get stretched out of shape, what happens to them as far as function?
Dr. Peljovich: Well depending on the amount of nerves that are injured sometimes they loose shoulder/elbow function, sometimes they loose everything. Then what we hope for in the first several months of life the nerves start to heal on their own and we kind of watch for that to see what's coming back, what's not coming back and at some point decide if there's any hope for future healing.
In a functional sense how much of a difference does it make when you do the surgery on these kids?
Dr. Peljovich: The children we normally operate on cannot get their hand to their mouth, they cannot raise their arm up to their head at all so the difference is enormous, it's really a difference between nearly a completely disabled arm and one that's functional and useful for them.
When you're using this donor where does this nerve come from and tell me a little about use of use(?)
Dr. Peljovich: The nerve is a cadaveric nerve so it's donor nerve, its tissue that's donated preserved and treated in a certain way so there's no longer any immune reactivity or disease possibility or anything like that, but anatomically is exactly identical to the nerves that these children or we have, so it serves as a perfect conduit to bridge the gap of a nerve defect which is often what we see in these children. The great thing about it is like the baby we just operated on we only needed 1 graft, but in other babies we may need a lot more and there's only so much donor nerve we can take without the baby actually losing some real function so the ability to this graft is not only easy, it saves a tremendous amount of time. But we now have many more options to reconstruct hands and arms than we would have using traditional methods.
Long term what does it mean to these kids?
Dr. Peljovich: Better outcomes we hope.
How many surgeries have you done would you say using the cadaveric nerve?
Dr. Peljovich: About 10 – 15
So this is still really really new…
Dr. Peljovich: Agrees
Long term do you think this is going to become more of a standard of care, do you think this has enough advantages over the traditional standard of care?
Dr. Peljovich: In terms of time savings and the fact that you can really get good nerve match for the defects that we're treating, if this proves to be as effective as traditional donor nerve, which so far its seems to be, then I think I will likely replace much of the donor nerves that we use today.
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