Dr. Harvey Chim performs peripheral nerve surgery for brachial plexus injuries, peripheral nerve injuries and peripheral nerve tumors.
Brachial Plexus Injuries
Overview
The brachial plexus is a network of nerves that come out from the spinal cord in the neck and travel down the arm (Fig. 1).
These nerves control movement and sensation in the shoulder, elbow, wrist and hand. Some brachial plexus injuries are partial and will completely recover in weeks to months. Other injuries are severe and can cause permanent disability in the arm. In complete injuries there may be no voluntary movement in the entire arm.
Causes
Motor vehicle accidents, falls, gunshot wounds, contact sports and childbirth (in infants)
How are brachial plexus injuries diagnosed?
Common tests include
- Imaging, such as an MRI scan
- Nerve conduction study and electromyogram
Treatment
Adult brachial plexus injuries are mostly caused by trauma. Many people recover spontaneously. For those who do not, treatment options may include exploration of the brachial plexus and nerve grafting and nerve repairs, or nerve transfers. In complete injuries, elbow flexion can be reconstructed through a free functional muscle transfer, where most commonly, the gracilis muscle from the thigh is transferred to the arm. Read more about Dr Chim’s published research on this area: Reconstruction of Pediatric Brachial Plexus Injuries With Nerve Grafts and Nerve Transfers and Free Functioning Gracilis Transfer for Traumatic Brachial Plexus Injuries in Children. Further surgery in the wrist and hand helps to optimize function in patients with complete brachial plexus injuries.
Brachial plexus birth injuries are caused by childbirth. Most recover spontaneously. For those that do not, treatment includes nerve surgery to repair injuries in the brachial plexus. Most children will require secondary shoulder and possibly elbow surgery at a later stage. An experienced multidisciplinary team is essential for the best outcome.
Peripheral Nerve Injuries
Overview
These injuries can include following various mechanisms of trauma, such as lacerations, crush injuries and gunshot wounds.
Types we treat
- Median, radial and ulnar nerve injuries
- Spinal accessory nerve injury
- Foot drop injury (injury to the peroneal nerve and sciatic nerve)
Peripheral Nerve Tumors
Overview
Nerve tumors can form in the peripheral nerves anywhere in the body. These often present as pain, numbness, weakness, burning or a palpable mass. Most tumors are benign.
Common types
- Neurofibroma: These are related to the inherited condition of neurofibromatosis
- Schwannoma: These are nerve sheath tumors and grow very slowly
Treatment
Symptomatic tumors can be removed surgically. In many cases nerve function can be completely preserved.