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FAQs

Following trauma if you have loss of function in one limb or loss of sensation in any part of your limb, we have to have a suspicion of BPI.
If it is mild nerve damage (Neuropraxia), the weakness will improve in a few weeks without any treatment.
If there is more severe nerve damage, then it may be permanent. 

Generally no investigation is required in the initial phase unless the trauma is severe and needs immediate attention. The 2 investigations that will help diagnose BPI accurately are-
a) MRI scan of cervical spine and Brachial Plexus
b) Nerve conduction study of the Brachial Plexus 

Surgery may be possible to repair damaged nerves. In order to have a chance of success this surgery must be performed within a few months of the injury.
Nerve Graft
Usually when the nerves are torn, the damaged segment of nerve, either side of the injury, must be removed and repaired using grafts from somewhere else (like the forearm or the lower leg area). The nerve graft acts as a guide through which new nerve fibers can grow and cross the gap caused by the injury. These nerves grow very slowly, recovery time is lengthy and complete recovery may be impossible due to the way that each individual microscopic nerve fibre grows in position.
Nerve Transfer
Undamaged nerves in the area that are doing less valuable jobs can be transferred to other parts of the brachial plexus to try and regain some function within the limb. As the nerves used in this transfer start to recover you will need to work very hard at retraining these nerves to move your arm and initially you may have to do different movements to make your arm work.
Tendon transfers
Each muscle has a starting point (origin) and tapers into a tendon that attaches onto bone (insertion). During surgery the origin is left in place and the tendon attachment/insertion is detached and reattached into a different place.  

Depending on the severity of lesion, recovery can be expected. If there is permanent weakness, some surgeries as explained in the website can be done to improve disability. Pain can be another limiting factor which can be treated with medicines or surgery. You may require psychological counseling to improve your mental health.

Pain is a sensory and emotional experience which can cause serious psychological changes in the person. Pain develops early in 90% of brachial plexus injury cases, and it may be also delayed for 3-4 months.Generally the pain improves by 2-3 years and is usually manageable by the patients. But in 30-40% of patients the pain becomes very severe and unbearable.

Some of the medications used to treat pain are:
Non steroidalanti inflammatory (NSAID’s) –These drugs include Diclofenac, Ibuprofen and others. They work by reducing hormones that cause inflammation and pain in the body and are used to reduce pain, inflammation and stiffness caused by many conditions. Paracetamol can be used with these combinations.
Tramadol– This is effective in the management of moderately severe acute or chronic nociceptive pain. It is often useful when administered with other drugs.
Anti epileptics e.g. gabapentin, pregablain, carbamazepine, lamotrigine, Gabapentin (Neurontin) – This is used to help relieve certain types of nerve pain, but has another use as it can also be prescribed for patients who need help to control seizures (convulsions) or epilepsy. This is usually started at a low dose and gradually increased until a benefit is seen. This drug should not be stopped abruptly. Lyrica (Pregabalin) or Gabapentin are the commonly used drugs.
Anti depressants e.g. amitryptyline, duloxetine– Amitriptyline is in a class of drugs called tricyclic antidepressants. It may be used to treat nerve pain but has another use in patients with symptoms of depression such as feelings of sadness, worthlessness, or guilt; loss of interest in daily activities; changes in appetite; tiredness; sleeping too much or insomnia. It is often given at night and can improve sleeping patterns but may take up to 2 weeks to notice any pain relief.
Topical medicines– E.g. gels, creams, patches
TENS (Transcutaneous Electrical Nerve Stimulation)– This is a small portable electrical device which is designed to help relieve pain. It works by sending a harmless electrical current through pads that are placed on your skin. This is felt as pins and needles and these feelings can help to block pain messages.
The surgical options available are:
• Nerve block surgeries
• Intrathecal pumps delivering painkillers direct to the area affected
• Ablative (destructive) surgeries, which involve the burning of nerve endings. 

Physiotherapy:
You can start exercises aimed at preventing joint stiffness. These exercises do not make the nerves heal any faster but keep joints supple and help you look after the arm. You may also get some help and advice with pain management.
You will be given a ‘sling’ to help support your arm and you will be advised on how and when to wear this. The length of time that your arm needs to be immobilized will depend on the severity of your injury and the healing of any other associated injuries e.g. dislocated shoulder or fractures of the arm.
Alternative treatments:
Treatments are aimed at improving the muscle mass and release spasm and stiffness. This can be achieved by medication, TENS machine, nerve stimulations and other alternative treatments like ayurvedic massages etc. These however do not improve function but help nerve recovery and prevent muscle wasting. In most cases time needs to be given to allow natural nerve repair.

The surgical options available are:
• Nerve block surgeries
• Intrathecal pumps delivering painkillers direct to the area affected
• Ablative (destructive) surgeries, which involve the burning of nerve endings.
DREZ lesion is a neuroabalative procedure which gives 70-90% pain relief following surgery.  

Following surgery, the pain relief is usually immediate and can be realized the very next day. Sometimes, it takes about 3-4 weeks before pain relief is achieved

The chances of being paralyzed after surgery is extremely rare and <1%. There may be very mild temporary weakness due to post operative spinal cord swelling. But this will improve in 2-4 weeks. If you have had any nerve graft procedure, this will not be affected by the surgery.

Neurophysiological monitoring is the method of maping the spinal cord during DREZ operation. This will allow the surgeon to accurately perform the procedure avoiding spinal cord damage and paralysis. There is still a 1 % chance that damage can happen.

The success rate with DREZ operation is about 70-90 % in long term studies. Generally most patients have complete relief of the electric shock like (paroxysmal) pain than the continues burning pain.

Yes, you can lead a complete normal life after the DREZ operation as you do not have to worry about the severe pain. Those who have a good success rate feel that they have a new life with a clear mind. This improves the quality of life both professionally and socially.

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