Restoring Function After Brachial Plexus and Quadriplegia

Video Published on January 11, 2019

In This Video

Brachial plexus is the bundle of nerves that exits the cervical spine, passes under the clavicle and into the arm. Injuries in the brachial plexus must be restored within a limited amount of time or its function becomes irretrievably lost
In this video, Justin Brown, MD, director of the Mass General Paralysis Center, describes a new, game-changing nerve transfer strategy that restores full function to the patient’s hand and applying that same strategy to quadriplegia

Brachial plexus is the bundle of nerves that exits the cervical spine, passes under the clavicle and into the arm. Injuries in the brachial plexus must be restored within a limited amount of time or its function becomes irretrievably lost. In this video, Justin Brown, MD, director of the Mass General Paralysis Center, describes a new, game-changing nerve transfer strategy that restores full function to the patient’s hand, and applying that same strategy to quadriplegia.

Transcript

Brachial plexus is the bundle of nerves that exits the cervical spine, passes under the clavicle and into the arm. It really animates all the muscles and all the sensation of the upper extremity. So, when a nerve is injured, its axons, or the wires that connect to the muscle that make them move, are lost. And a muscle doesn't survive forever without having those connections.

And so they must be restored within a limited amount of time, of that muscle atrophies and undergoes fibrosis, and it becomes irretrievably lost. And options have really increased over the last decade. It used to be that we would try to go find the injury in the neck, or where it was avulsed from the spinal cord, and lay in nerve grafts.

The new strategy, which has really become a game changer for us, has been the idea of a nerve transfer. And a nerve transfer is taking a nerve that you already have control of, it's still working, and being able to splice it or take a branch of it, and redirect that to the muscle that is critical to recover.

When I say splicing, it's we can actually open a nerve up, and within a nerve is a bundle, just like in a coaxial cable, a bundle of nerves within it essentially. So, we open what's called the epineurium and we can actually peel out a little sub nerve within that nerve, and suture that to a branch.

In doing so, we certainly lose axons to a subset of muscles within the forearm and hand, but as long as it's less than a 50% axon loss, those motor units will simply enlarge, and we actually have no cost to it whatsoever. The patient has full strength in their hand, and then they get a full bicep out of it as well.

Many of the topics that we're discussing to recover function after brachial plexus injury turns out can be applied just as effectively to other injuries that have been, until now, more neglected. So, spinal cord injury has now been an entity that we can treat with the same nerve transfers that have been applied to brachial plexus injury.

And the nice opportunity in some of these other injuries is that the window for doing a nerve intervention is much wider than it is for brachial plexus injuries. Now we've been able to apply these to stroke and to brain injury as well. Where the strategy now is both reducing spasticity and redistributing function to the muscles that are the most critical for the patient to regain the ability to reach, grasp, bring their hand to their mouth, even walk better.

So, the same principles that apply to brachial plexus injuries, which are very complex injuries, can be applied to spinal cord injury, can be applied to stroke, can be applied to traumatic brain injury, or any neurological situation which has left the patient with impaired function. And our group probably has the greatest experience in the world with these types of injuries, with these interventions.