I heard that I could come to this site and get an honest answer to a difficult question. Our 23-year-old son was involved in a work-related accident. There were multiple injuries but the worst is what they call an avulsion of the brachial plexus. Right now his arm is paralyzed but the surgeon is going to do a C7 nerve transfer. There are no promises about the results. What can you tell us about recovery, prognosis, anything?
As your son has unfortunately experienced, trauma to the neck and/or arm can be severe enough to pull the brachial plexus right off. This injury is called a brachial plexus avulsion. A nerve plexus is an area where nerves branch and rejoin. The brachial plexus is a group of nerves in the cervical spine (neck) from C5 to C8-T1. This includes the lower half of the cervical nerve roots and the nerve root from the first thoracic vertebra. The nerves leave the spinal cord, go through the neck, under the clavicle (collar bone) and armpit, and then down the arm. The final branches result in three nerves to the skin and muscles of the arm and hand: the median, ulnar, and radial nerves. Brachial plexus avulsion injuries don't just cause pain and numbness in the shoulder, arm, and hand. This injury disrupts nerve messages to the shoulder, arm, and hand so like in your son's case, the person's arm becomes paralyzed. Efforts to find ways to restore nerve function have resulted in the refinement of the contralateral C7 (CC7) nerve transfer you mentioned. In this procedure, a portion of the C7 nerve from the uninvolved (uninjured) side of the neck is cut and used to reattach the avulsed or ruptured nerve on the other side. This can be done without causing any sensory or motor loss on the donor side. The CC7 nerve transfer was first tried in the early 1990s with mixed results. Up to half the patients had some improvements in one study. But other surgeons reported much poorer results making them wonder if it was worth doing this procedure. The recovery time is long and the rehab required is extensive. But some surgeons have persisted in trying to improve the technique with the thought that for someone who is paralyzed, any amount of improvement is worth it. And from the results reported in a recent article on this topic, it seems the patients would agree. Most of them do not regret the extensive surgery or the long recovery and rehab. And for those who are compliant (following the surgeon and therapist's directions), results are reportedly good. In that study there were 101 patients who had this procedure done, everyone was able to get some shoulder motion back. Depending on which nerves were transferred, rate of recovery for elbow flexion was high. The most difficult recovery was finger flexion. Regaining some sensation was common but movement was more difficult to restore. If the patient had even protective sensory recovery (ability to feel hot, cold, pressure), then the procedure was still considered a "functional" success. The patients in the study who were treated with a CC7 transfer were still considered "disabled." But they were far more functional than they would have been if the arm and hand remained totally paralyzed. After reconstructive surgery with the nerve transfer, they could use the injured hand to hold small or light objects, assist with dressing and self care, and even hold a light brief case, bag, or purse. Right after surgery, patients should expect to be in a neck brace for the first three weeks. Physical therapy begins after that short period of immobilization. The therapist works with the patient to help them regain motor function and control. Patients must be prepared for an intense, focused period of rehab lasting years. For example, shoulder motions on the healthy, normal side are encouraged up to 1,000 times a day for at least three years. It can take up to four years for some patients to regain as much sensory and/or motor recovery they are going to get. Complete independent function of the arm and hand isn't promised but improved function is possible. During this time, they must remain dedicated to their exercise program. As the results of this study showed, those who stuck with it were rewarded with the best results. Once there is some nerve recovery, additional surgery including muscle transfers may be needed.