November 19, 2010
A nagging pain in her shoulder sent Cathy Shelton* to her doctor looking for relief. She thought it was just a muscle strain, but the MRI told a more frightening story. Cathy had an egg-sized tumor in her brachial plexus (a complex set of nerves branching off the spine from the base of the neck to the chest), which controls the muscles in the hand, wrist, elbow and shoulder.
Because the brachial plexus contains such a maze of nerves, few physicians have the expertise to perform surgery in this area. Without the ability to perform a biopsy, Cathy’s doctor thought the tumor in her brachial plexus was a sarcoma, a type of cancer that develops from tissues such as bone or muscle. The tumor would require intricate surgery to be removed, and the risk of Cathy losing function from damaged nerves was high.
“I contacted surgeons throughout the country and no one wanted to touch me because the surgery was so complex,” Cathy says. “It was so frustrating and I was fearful for my life. I spent months trying to find a surgeon to remove the tumor, but it was above the skill sets of most.”
Then she heard about Susan Mackinnon, MD, a nerve repair specialist and Washington University chief of plastic and reconstructive surgery at Barnes-Jewish Hospital. She is considered a pioneer and an international authority on nerve regeneration, nerve transfer and nerve transplant.
Dr. Mackinnon is also the Sydney M. Shoenberg, Jr. and Robert H. Shoenberg Endowed Chair in Plastic and Reconstructive Surgery. Her research at the Tal Nerve Research Center at Barnes-Jewish is supported in part by gifts to the Barnes-Jewish Hospital Foundation. She is one of just a few surgeons in the country who perform brachial plexus surgery. She also performed the first nerve transplant in 1988 and now focuses on nerve repair and transfer.
Through nerve transfer, Dr. Mackinnon has changed the traditional approach to treating nerve injuries. Nerve transfer involves rerouting a patient’s own healthy nerves into areas left paralyzed by damaged nerves, so that patients typically recover much function, movement and strength.
“With nerve transfer, we think about function, not injury site. For example, for a brachial plexus injury, we transfer a working nerve to the front of the arm muscle rather than trying to repair the injured site in the shoulder. Time is muscle, so we have to get nerves quickly to where they can start regenerating and keep the muscles functioning,” says Dr. Mackinnon.
Traveling Across the Country for Expert Care
After researching Dr. Mackinnon further, Cathy wasted no time coming from her home in California to see the worldrenowned nerve surgeon in St. Louis. “Dr. Mackinnon was direct and knowledgeable, and I immediately had confidence in her.”
Because Cathy’s brachial plexus surgeries and nerve repair were so extensive, they had to be done in stages. During Cathy’s first surgery in 2006, Dr. Mackinnon removed the tumor and performed a nerve transfer in Cathy’s arm.
“She saved my life when no one else would touch me,” Cathy says.
Dr. Mackinnon also discovered that Cathy actually had lymphoma (a type of blood cancer that involves cells of the immune system and has a tendency to recur) rather than a sarcoma. This was a crucial diagnosis, as treatment for lymphoma is different than treatment for sarcoma. After surgery and two months of infusion therapy, Cathy’s cancer went into remission for almost a year.
Cathy came back to Dr. Mackinnon in 2007 after she began losing function in her hand. Dr. Mackinnon found the lymphoma had recurred in Cathy’s arm. Cathy began infusion therapy again, and Dr. Mackinnon performed additional nerve repair. Today, Cathy is in remission again.
“Dr. Mackinnon saved my life twice,” she says. “She’s top-notch in my book.”
Sharing Knowledge, Supporting Research
Dr. Mackinnon calls peripheral (arm and leg) nerve surgery an “orphan field” since it is an often-neglected area of medical and surgical treatment. However, Barnes-Jewish Hospital provides treatment for peripheral nerve injuries and disorders through the Center for Nerve Injury and Paralysis, which includes a multi-disciplinary group of surgeons and specialists with unique expertise in this area. Dr. Mackinnon is one of just a few peripheral nerve surgeons in the country, and she would like to have more company in order to help patients in need.
“I want to make the operation more accessible,” Dr. Mackinnon says. “With nerve transfer, even brachial plexus surgery is simpler to perform.”
Currently, Dr. Mackinnon is studying other methods to speed nerve regeneration. She says research in peripheral nerve repair desperately needs support.
“It’s an important area that’s vastly underfunded. Nerve injuries caused by tumors, surgery or trauma are such a big problem and affect people of all ages and walks of life.”
To support Dr. Mackinnon's research, please give to the Barnes-Jewish Hospital Foundation's Peripheral Nerve Research Fund (#7162) by using the enclosed envelope or donating at www.GivingBarnesJewish.org. If you have questions, please call David Sandler at 314-362-3499 or e-mail email@example.com.
(*Not her real name. Patient wishes to remain anonymous.)