Getting the Nerve: Restoring Movement to a Young Man's Arm

When Chris Haralambous arrived in the emergency room with a gunshot wound to his right bicep, he thought the bullet had broken his arm. But an X-ray showed that no bone was broken. In fact, the doctors who treated him said that the wound was superficial. "But I couldn’t move my finger or hold up my wrist," recalled Chris. "Then the orthopedist came in and said that I had a nerve injury. I didn’t know what that meant." As the two talked further, Chris felt reassured that such injuries can recover on their own. In fact, he was sure that his would, even though the doctor also said that in some cases a patient requires surgery and, in the worst cases, they never improve at all.

Chris, 23, of Glastonbury, Conn., returned to college and undertook the challenging task of learning to take notes and tests with his left hand. "It was the hardest time in my life," said Chris. After several weeks, his finger and the muscles that supported his wrists were still not functioning and showing little improvement. Instead of the recovery he had imagined, Chris found himself applying for "student with disability status," in order to have more time to complete exams. "That was a terrible day," Chris recalled.

In the months following his injury, Chris worked with a physical therapist to strengthen his working muscles and possibly regain some function in his hand. Although some movement returned, he was still unable to perform basic tasks such as writing or typing. The small piece of shrapnel that remained in his bicep, which was a millimeter away from one of his nerves, irritated and injured it further each time Chris extended his arm. The movement was also wearing away the nerve sheath and causing a neuroma. "The pain was terrible. Each time I extended my arm it was a horrible shock – pins and needles – even from the slightest movement," explained Chris. He consulted several specialists in his area for help. "One doctor said I didn’t need surgery, another said I needed it and a third said I needed a tendon transfer," he recalled. "I had no idea what to do."

To make matters worse, among Chris’s friends was a young man who had suffered a similar injury from a biking accident. "He didn’t get the right help," said Chris. "He ended up with permanent nerve damage and paralysis. I didn’t want to be like him."

Chris continued looking for answers. His mother suggested that Chris consult with someone a friend recommended, Dr. Scott W. Wolfe, a hand and upper extremity surgeon and director of the Center for Brachial Plexus and Traumatic Nerve Injury at Hospital for Special Surgery in New York City. Chris’s therapist, too, mentioned Dr. Wolfe’s name, and so Chris reached out to yet another specialist in hopes of finding a solution.

When he called Dr. Wolfe’s office, they asked him to come in to see Dr. Wolfe right away. "As soon as I went through my exam with Dr. Wolfe, I knew he was different from the other doctors I had seen," recalled Chris. "He was very thorough, he ran tests, he covered all the aspects - electrodiagnostics, X-rays, everything. And it all took place on the same day."

Dr. Wolfe told Chris that there were signs of recovery to his injury, and that the nerves hadn’t been cut all the way through. He recommended that Chris continue his therapy for a few more weeks to see if there was any additional improvement. If there wasn’t, he should come back.

Chris left Dr. Wolfe’s office feeling optimistic, since there seemed to be a possibility for recovery without more surgery. He performed his physical therapy with more determination than ever. "But I didn’t improve any more," recalls Chris.

He returned to Dr. Wolfe discouraged. "He re-examined me and said, ‘If I were you, I would have it fixed,’" recalled Chris. "Knowing that I was in the hands of such an experienced doctor and his complete confidence in the procedure and how I would respond to the surgery allayed any fears I would have had," recalls Chris. A week later, Dr. Wolfe performed nerve transfer surgery on Chris’s arm. The procedure involved harvesting a nerve from Chris’s right leg, grafting the piece of nerve into the injured area in his arm, and preserving the damaged -- but still functioning -- portion of the injured nerve. The shrapnel was also removed. Following surgery, Chris felt like he was back at square one. Any of the original recovered movement was gone.

"I kept up with the physical therapy and after a while there were flickers of movement," he said. Within four months, Chris was able to fully extend his wrist and some of the muscles of his arm came back to life. "They had lain flat for months and then suddenly you could see their definition again," recalled Chris. After 18 months, he was fully extending his arm, able to play a game of ping pong and type on his computer and he’s received the okay from Dr. Wolfe to start working out again.

Despite all the physical therapy, surgery, and time recovering, Chris was able to graduate from college on time. Prior to his injury, he had planned to pursue a graduate degree in business. Now, however, after his experience with health care, especially the care he received at HSS and from Dr. Wolfe, Chris is seriously considering becoming involved in medicine.

"My whole experience at Hospital for Special Surgery and with Dr. Wolfe has inspired me to find a way to give back," he said. Currently, Chris is the administrator of a website he has developed for patients with nerve injuries, NDSupport.org.

"I want to assist people in getting the help they need and knowing where to go," he said. "This online community will reach people who feel cut off from support and steer them in the right direction."

For more information please visit www.hss.edu/getting-the-nerve-restoring-movement-to-a-young-mans-arm.asp