Usually a young man driving a motorcycle falls with the impact in a neck. This causes injury to one or more of the five nerves which provide sensation and power to the upper extremity. If these patient do not show recovery in a couple of month, they will require surgery, the surgery involves microscopic techniques of nerve repair, nerve grafting, nerve transfer or neurotization.
The child was born after a difficult labor, the parents noticed that the child is not able to move the shoulder and the elbow. Baby was unable to elevate her shoulder and unable to reach out to objects due to paralysis of certain muscles of the shoulder. The child was 5 years old at the time of first presentation.
A technique of tendon transfer was utilized to re-activate the shoulder to lift up the shoulder (Abduction) in the sky and reach out as well (External rotation). If the child presents early and at the age of 3 months if the child is unable to flex the elbow, one must offer nerve surgery. In late presentation like here, consider tendon transfer.
Volkann's Ischemic Contracture
The child sustained a fracture of his elbow, the plaster was applied. Later he developed certain contractures called as Volkann's Ischemic Contracture or VIC.
He was unable to flex his fingers and had no sensation in the fingers. The first surgery was in the form of neurolysis of the median nerve and the ulnar nerve. He made remarkable recovery of the sensation. In the absence of any recovery of the finger flexion, second surgery was undertaken. A tendon was mobilized from the back of the wrist and used to provide power to the finger flexors (ECRL to FDP).
Before & After Surgery
The patient presented with progressive weakness of finger, clumsiness of finger movements and inability to extend the fingers.
She was investigated and was found to have a lump in the elbow region, compressing the radial nerve. The lump was removed protecting the nerve. In due course, she had full recovery.
Lump being extracted from under the nerve
India's Top Rated Hand Surgeon
Dr. Pankaj Jindal, Master of Surgery in Orthopaedics. Fellowship in Hand Surgery, Microsurgery & Research in France & USA.
Dr. Pankaj Jindal
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