Your Stories

Brachial Plexus Injury

ROSS REBBECK

Recent statistics (1998/99) show that about 500 brachial plexus injuries are treated in UK hospitals annually, and that motorcyclists suffer the majority (nearly 90%). So much so, in fact, that BPL is known as "The Biker's Injury" throughout the NHS. It's a complex subject, so I shall attempt to briefly explain the major points.

The two brachial plexuses are web-like formations of nerves located below the collarbones in the human body. All the sensory and motor nerves serving the arms pass through these processes, after leaving the spine, as well as certain others whose functions are as diverse as control of facial muscles to control of the muscles in the diaphragm. (Until recently, a half-closed right eye and long bouts of hiccuping accompanied the loss of use in my right arm.)

The primary cause of this injury is violent trauma in the area of the neck and shoulders, which is often accompanied by serious damage to the surrounding area. A common cause is landing shoulder first on the road after a spill - the head is pushed sharply to one side and the resulting traction leads to nerves getting torn. (In my case, two were plucked right out of the spinal cord and repair was not possible.) Immediate diagnosis and treatment is required for nerve surgery to succeed in restoring function, and we are lucky to have several of the world's leading neurosurgeons working within the National Health Service.

However, the nervous system is so complex - both to understand and to work on - that complete restoration of function and/or removal of pain is never likely to occur in many cases. Although it must be said that new techniques are constantly being developed by these dedicated pioneers; hopefully this may offer encouragement to future victims of this painful and crippling condition.

In my experience, there are two forms of disability involved with this injury. Loss of function in an arm is pretty devastating, especially if you earn a living in the building trade (as I did) or any other manual skill i.e. from bricky to brain surgeon. But it is possible to adapt, as shown by the 400 or so NABD members currently riding BPL-adapted bikes and trikes throughout the UK.

As well as getting back onto my beloved XS650, I've completed a 2,000 brick wall round the front of my house - though I wouldn't want to boast about how long that took! I have also met a local man who rides a trike he built himself and uses it to compete in hill climb events, one-handed; as well as a Yorkshire gentleman who has clocked up half a million miles on various outfits, using only his left hand to steer. So it's pretty clear that just having a single arm is no great barrier to enjoying life in the saddle.

Which is just as well, really, as it's always good to find a distraction from the second major problem presented by the B.P. Lesion - the PAIN!

This again divides into two categories, though all of it is intermingled. Firstly, there are the inappropriate and exaggerated signals that the damaged nerves send to the brain. This is called neurogenic pain and it's really frustrating as there is no obvious cause or treatment. (I used to take enormous, liver-crippling doses of dihydrocodeine until I realised that the disadvantages well outweighed any beneficial effects.) With luck, the passage of time and the initial nerve surgery will turn this round - it's been three years and I'd like not to feel as though my hand was in a chip-fryer all the time!

The second major cause of pain is subluxation of the shoulder. This medical term is used to describe the effect of gravity on an inert arm (plus any titanium steel that may be present), especially where the muscles of the shoulder are atrophied. This results in the ball-joint of the upper arm being drawn down, i.e. dislocated, from its socket and this, as you may imagine, is deeply uncomfortable.

Until recently, the NHS had no mechanical answer to this problem beyond the use of a "collar and cuff" sling or the ubiquitous "flail-arm splint".

Please note that I am not knocking these devices - the latter is especially useful with its various attachments - but neither is able to prevent this painful condition. But a new answer to this problem is now available:

On my last visit to the Royal National Orthopaedic Hospital at Stanmore, back in Autumn '98, I was given details of the Wilmer orthosis, which is currently marketed by Ambroise UK of Somerset. Due to the financial constrains on Departmental funding (where have we heard that one before?) the device was not available on the NHS, but it looked so promising that, desperate for some relief, I contacted the firm direct. This led to a home visit from Ken Spooner, the driving force behind Ambroise UK, and, after a chat and a demonstration, I decided to go for it. To my surprise, Ken produced an impressive tool-kit and we immediately adjourned to my garage/workshop where a customised fitting was carried out in just half-an-hour! Being used to the usual lengthy wait for NHS hardware - innumerable fittings and adjustments, plus travel to and fro - it was really good to get fixed up so easily and conveniently. And I've been wearing it ever since!

For the technically minded among us, I'll attempt a short description. The harness consists of a soft leather shoulder-pad held in place by an adjustable chest strap, while the suspension clasp is hung from a second strap under the armpit. The second and final component is particularly trick, consisting of a lightweight (170 g) stainless-steel framework which fully supports the elbow, forearm and hand. This is neatly suspended from the harness and, due to the clever positioning of the pivot point, causes the weight of the forearm to push the upper arm upwards - thus relocating the joint in its original, pre-injury position. The materials and stitching are first-class, it's easy to fit one-handed and it's comfortable on the skin. And that's right, I did say skin, 'cos, unlike the "collar-and-cuff", the whole issue can be worn under any clothing with a fairly full cut e.g. a NABD sweatshirt, and is quite unnoticeable (I only need to use my faithful flail-arm splint on the Yam nowadays, and I'm currently investigating the possibility of building the new device into a leather jacket - enquiries are welcome).

Basically, the Wilmer orthosis has made a large and positive difference to my coping with this disability and I'm very glad to have found it.

Finally, best wishes to all you fellow member who are struggling with the burden of a disability.

Take care, ride free - I'll see you out there! you out there!