Surgery can be a nerve-racking and anxiety-inducing process under the best of cases. Nerve reconstruction surgery to repair a traumatic nerve injury (such as a brachial plexus injury) or limb paralysis caused by a viral infection (i.e., enterovirus EV-D68) may be stressful for both mind and body, as may be the lengthy recovery process. Talking about the recovery process and our expectations with our medical providers ahead of time may help reduce overall stress and anxiety, and help improve our quality of life.
The goal of nerve reconstruction is to gradually restore function and mobility to the affected limb. In time, patients with successful outcomes will be able to return to an active daily lifestyle. Many patients feel anxious as they wait to see signs of successful recovery. However, it’s important to understand that results won’t be seen right away! Recovery is a marathon and not a sprint: think in terms of months and years, not days and weeks. Remember that high levels of anxiety and stress have been linked to slower healing—managing stress and anxiety makes a difference!
So what actually happens during nerve construction and why does the recovery take such a long time? During nerve reconstruction, healthy donor nerves are harvested from another part of your body and connected to the damaged nerve(s). Over time, the healthy nerve fibers grow from where they were connected to the damaged nerve, down its entire length, to where the nerve and muscle meet and communicate at the neuromuscular endplate. This means that the new healthy nerve fibers growing through the damaged nerve also need to grow into the affected muscle to make a successful connection. Once the nerve and muscle connection has been made, it must develop and mature before the muscle can flicker back to life to restore function and mobility to the affected limb.
Healthy nerves tend to heal at a rate of 1 inch per month. Keep in mind that recovery time will depend on how much distance the growing nerve needs to cover. Successful nerve growth to the neuromuscular endplate may take as long as 6-12 months after surgery. After this period, nerve maturation and initial muscle recovery may take 12-18 months. Remember our body is hard at work healing before any electrical recovery can even be detected in the growing nerve fibers!
What can we do while our body is directing energy to growing new nerve fibers? Active participation in physical therapy throughout this process helps to keep the nerves firing, so your body knows to
- keep the connection alive and healthy
- bulk the muscle up so that it can be used again in the future.
You may not feel what is happening or even notice changes on a day to day or even week to week basis, but trust that healing is occurring even if you cannot see it.
Many factors can impact your healing rate including age, general health, stress, treatment plan adherence, alcohol/substance/tobacco use, and even sleep. At some point you will most likely feel moments or short periods of being anxious, frustrated, discouraged, hopeless, angry, impatient and sad amongst other feelings. If these feelings persist for more than 2 weeks, discuss with your mental health treatment professional or primary care physician.
Everyone recovers at a different pace — this is normal and to be expected. Just because you don’t feel or see the recovery happening, doesn’t mean that it isn’t happening at all. Before you get overwhelmed, talk to your support system, do activities that help you manage your emotions and stress levels, and focus on what is working and what you are grateful for each day. It’s okay to distract yourself with healthy activities, check in with your treatment team, and perhaps consider finding mental health counseling or peer support to help you through the recovery process.
Rest assured: recovery is a lengthy process. Always consult your medical provider and treatment team with any concerns you may have relating to your injury and recovery process. Talk to your treatment team about your goals for surgery and recovery. Listen to and stay aware of what results are expected at what time points. This keeps us motivated to stay involved with physical therapies, keep to our treatment plans, and happier with the gradual return of functioning and mobility in our limb that hopefully we’ll one day be able to use again.
Schneider K. Rancy, BA is an office and clinical research assistant at Hospital for Special Surgery. As part of the research team on the Hand and Upper Extremity Service, he conducts research on distal radius fracture fixation, patterns of degenerative and inflammatory arthritis of the wrist, salvage procedures for wrist reconstruction, and long-term motor outcomes following nerve and brachial plexus reconstruction.
Zoe A. Landers, LCSW is a licensed clinical social worker at the Center for Brachial Plexus and Traumatic Nerve Injury (CBPTNI) who evaluates and facilitates treatment for brachial plexus injured patients experiencing psychological and psychosocial stressors following injury. Ms. Landers has actively participated in research with the CBPTNI multidisciplinary team to develop a deeper understanding of the psychosocial and psychological impact of brachial plexus injury. Findings from this research have been presented at major hand and upper extremity orthopedic conferences.