VCU news

By Joe Kuttenkuler

RICHMOND, Va. (Dec. 7, 2004) – The Virginia Commonwealth University Medical Center has established a clinic for diagnosing and treating injuries of the peripheral nervous system – the complex network of nerve fibers that traverses the body outside the brain and spinal cord.

The primary focus of physicians in the VCU Nerve Clinic is the dense, cable-like bundle of nerves called the brachial plexus that conducts signals from the spine to the shoulder, arm and hand.

Brachial plexus injuries usually result from a trauma, such as a fall or motor vehicle accident, when the head is pushed in one direction and the shoulder in another. In rare cases, babies can suffer brachial plexus injuries as they pass through the birth canal. The force can stretch or completely sever nerve fibers, resulting in debilitating pain, lack of muscle control and, in some cases, a complete loss of arm function.

“Dealing with nerve injuries requires a great deal of patience on the part of the patient and the physician,” said Scott Graham, M.D., associate professor of surgery in the Department of Neurosurgery at the VCU Medical Center. “Depending on the severity of the injury, we may need to wait several months to allow time for the nerves to come out of shock before we can even begin diagnostics.”

To diagnose the extent of the injury, CT, or computed tomography, scans are performed to gain baseline information about the condition of the nerve bundle or plexus, and whether the nerves have been damaged at the spinal cord. A series of nerve-function tests also is performed in which impulses are selectively sent down various nerves to determine which ones are working. Based on the test results, doctors may choose to initiate immediate repairs, or to delay treatment to allow time for the damaged nerves to show signs of recovery.

“We don’t want to operate on nerves that are likely to recover on their own,” said Jonathan Isaacs, M.D., assistant professor in VCU’s Department of Orthopedic Surgery and assistant professor of plastic and reconstructive surgery. “But we also don’t want to wait too long to begin repair because muscle tissue will deteriorate without nerve impulses.”

Some brachial plexus injuries may heal without treatment. More severe damage requires surgery and physical therapy. The VCU Nerve Clinic offers patients a variety of treatment options. Together, Isaacs and Graham have used nerve grafts, transfers – taking a functioning nerve and splicing it with a nonfunctioning nerve – and muscle transplants to restore function to patients who previously had none. 

“The surgery is a very complex, time consuming process, which is why Dr. Graham and I like to work together,” said Isaacs. “It is amazing that you can take a functioning nerve and “wire it” into another area to restore function.”

Because nerves grow slowly – a millimeter a day – recovery from nerve damage can take months or even years, according to Isaacs. He advises patients they may not return to their full pre-injury condition. “But often just restoring some movement where there was none is a benefit for which patients are grateful.”