One Sunday afternoon, Emerson was helping his elderly father get into bed when a loud pop disrupted an otherwise quiet moment. He wasn’t sure if the sound came from him or his father, but then the pain set in and Emerson knew he’d hurt himself. The long head of the bicep muscle in his right arm had torn away from the bone.
Emerson’s doctor referred him to a surgeon for muscle repair. During the surgery, Emerson’s radial nerve was damaged. This nerve, which runs along the underside of the arm, is crucial to arm movement. Instead of improved function, Emerson’s arm was now paralyzed. After surgery, there was a chance the nerve would heal and Emerson would regain use of his arm, but this didn’t happen. It looked like he would have to learn how to perform everyday tasks—eating, writing, typing—with his single functioning hand.
“I didn’t have control over my arm. It was just limp. I couldn’t grab items, I couldn’t hold a toothbrush,” Emerson says. “I wasn’t able to perform my usual daily tasks.”
Fortunately, Emerson learned about Susan Mackinnon, MD, a Washington University reconstructive surgeon at Barnes-Jewish Hospital and chief of the Division of Plastic and Reconstructive Surgery. Mackinnon is a pioneer of nerve transfer surgery: moving an undamaged nerve from one part of the body to a new location, where it works as a replacement for a damaged nerve. Using this procedure, Mackinnon and colleagues have restored movement to patients with paralysis and repaired traumatic injuries.
This kind of “borrowing” to repair the body is fairly common. “Reconstructive surgeons do something similar to nerve transfer surgery when they take something expandable—say, bone from the hip—and use it to replace a missing bone,” Mackinnon says. “It shouldn’t surprise us that there are expendable components inside a nerve. I use them to replace damaged nerves.”
And that’s exactly what Mackinnon did for Emerson. She removed undamaged nerves from one part of Emerson’s arm and attached them in a new location where they could restore lost function.
Movement doesn’t return immediately after surgery, however. The transferred nerve has to be taught how to do new things. Physical therapy and hard work helped Emerson learn how to use his hand. Today, with the surgery and three years of therapy behind him, he can now do what once wasn’t possible.
“I’ve regained 85 to 90 percent of the use of my hand,” Emerson says. “I had to train the new nerves to behave like the old nerve, and it took time. But I am now able to do for myself."