His Last Hope: Muscling Through a Brachial Plexus Injury

Stephen Cook makes his living doing rustic furnishings. His work routinely brings him into the woods of his 110-acre farm in the Southern Adirondacks. Five years ago, on October 30, Mr. Cook was harvesting a tree on his farm when a dead branch fell, hitting him, and fracturing his skull, arm, neck, and back. "This tree was a monster," says Mr. Cook. "When the top went down it wrested loose a dead limb and I never saw it or heard it. It came straight down from about 80 feet up."

His brachial plexus, the web of large nerves that originate from the spinal cord in the neck and direct the movement and sensation of the entire upper limb, had been severely injured. Knocked out from the impact of the branch, Mr. Cook awoke to find his arm just swinging. He made his way to a main road—about one-third of a mile away, where an off-duty nurse found him and sent for help. He was medivaced to an Albany medical center, where physicians stabilized him, but could offer no treatment for his now paralyzed arm.

"I rode snowmobiles, hunted, and then, ‘hey buddy, you've got only one good arm!' The local doctors painted such a bleak picture that I was contemplating amputation," recalls Mr. Cook. "I dealt with that for a few months, and then I Googled brachial plexus. Dr. Scott Wolfe's name popped up. I called him and he told me time was of the essence since it was already five months past the date of the accident. From the time I called him to the time I was in surgery was less than two weeks."

"A brachial plexus injury can have a devastating impact on upper limb function, potentially affecting – as in Mr. Cook's case – the muscle power of the entire arm," says Dr. Wolfe. "There is a small window of time that if you don't get a spark going in the muscle, it's never coming back. To allow regenerating nerves to connect with paralyzed muscles and restore muscle function before dense scarring develops, nerve reconstructive surgery is ideally performed within the first three to five months after an injury.

"Dr. Wolfe ran through many scenarios with me about what he might find, and I said basically, you don't know until you get the hood up, right? He said, 'right.' So I told him, ‘just see what you can do for me.' I was already going to lose the arm."

During a lengthy surgery, Dr. Wolfe discovered that the nerve damage was more extensive than expected. Says Dr. Wolfe, "He basically tore all the nerves in his arm, which had to be put back together. Recovery from brachial plexus surgery is measured in months and years rather than days or weeks. At four to eight months after surgery, patients will experience a flicker of muscle recovery, with a gradual return of strength and mobility. Mr. Cook wouldn't let anything stop him. He had a great attitude and was going to muscle through any problems."

"My bicep started twitching about ten months after surgery," recalls Mr. Cook, "I noticed just a little twitter. I was like, ‘whoa, cool.' I worked it hard. Once I could make my arm move just a little bit, I began pool therapy two to three times a week for eight months. About a year from that first twitter of nerve, I was able to raise my arm." Today, at 42 years old, Mr. Cook continues to make furniture, He can drive and operate a chain saw and a drill. His bicep strength continues to improve monthly, and with the reconstructive surgery performed by Dr. Wolfe, he can raise his wrist and open his hand.

Says Mr. Cooke, who is married and has two children, "Coming to Hospital for Special Surgery was my last hope."

For more information please visit www.hss.edu/muscling-through-brachial-plexus-injury.asp