Newsletter: a surgeon & physio answer your questions

Newsletter: a surgeon & physio answer your questions

When I had my nerve injury my muscles wouldn’t work no matter how hard I tried. Now they move a little will they ever get better?

Thank you for your question; I’ll try to answer it clearly;

Nerve injury can lead to denervation, the cables being disconnected from the muscles. Like unplugging a TV, the muscles will no longer work. Muscles damaged by denervation are what we call flaccid, which means floppy not able to contract at all. When a nerve regrows into the muscle it can start that muscle moving again. This starts off very weak, just a visible flicker, but can then get stronger. We think muscles often get back to only around 1/3 to a 1/2 of their original strength.

The contracting is only part of what muscles do though – they are a very complicated organ and nerves control all the functions of muscle. All of these can be affected by nerve injury. Many people describe pains in the muscle from deep aches to sharp pains, that the arm tires very quickly, that they can’t control the movement without a lot of thought and concentration. They may also find the arm or leg feels stiff and resistant to moving as the opposing muscles are fighting each other and they can’t feel for sure what position the arm or leg is in. All of these are features of reinnervation of muscles that we are just starting to find out about. Physiotherapy can improve these features, as well as muscle strength, but at the moment there is no medical intervention (e.g. drugs, surgeries) we as a medical team can prescribe to improve that. These features probably never return to normal.

That is why with the CNE we are working on understanding these symptoms more. Working to see how to improve the growth of nerves into all parts of the muscle and how to keep the muscle cells at their happiest. We hope to provide therapies for patient benefit from this work and would love to hear from you if you have these symptoms and want to help support research in this area.

Mr Tom Quick. Consultant Surgeon, Peripheral Nerve Injury Unit, Royal National Orthopaedic Hospital

What are my options in terms of strengthening my arm and are there places that offer this type of support?

This question is quite difficult to answer as we tend to focus our exercises towards specific muscle groups and tasks/hobbies that the individual would like to complete. If individuals would like to build up their general strength then their GP can refer them to a local gym and instructor who is qualified to design a programme for patients who have long term health conditions.

Hazel Brown. Specialist Physiotherapist, PNI and Shoulder Unit, Royal National Orthopaedic Hospital

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