Connections is a quarterly newsletter for primary care providers covering the latest developments and advances in medicine at OHSU. Learn about the many clinical, education and outreach resources available to you and your patients.
From OHSU Brain Institute
Neuropathic pain and paralysis are challenging pathologies that can seriously affect patients’ emotional well-being and quality of life. With complex nerve conditions, prompt treatment gives patients the best chance of a successful outcome. OHSU is the only center in Oregon with microsurgical procedures for nerve transfer to restore muscle function and sensation, including brachial plexus reconstruction, peripheral nerve transfers and free functional muscle transfers.
Clock is ticking for nerve transfer in peripheral nerves/brachial plexus reconstruction
Weeks matter in peripheral nerve transfer. A “wait and see” approach by a patient or physician hoping for spontaneous improvement may take this option off the table. A nerve injury that is missed or misdiagnosed can also cause detrimental delays. The waiting time before consulting a specialist should not be longer than three months, and sooner is better. Some nerve reconstructive procedures are indicated at two to three months following injury and have diminishing results after this point.
Nerve transfers are often contraindicated after 12 months post-injury, and some are no longer available after only six months. Beyond this short, critical time window, most nerve transfers designed to restore movement become ineffective.
Facial reanimation can restore facial movement and smiles
The facial nerve specialist team can treat both acute and prolonged cases of paralysis, including congenital paralysis. Ideal timing for reinnervation treatment and nerve transfers is less than a year of paralysis and preferably within the first six months. For cases with prolonged or congenital paralysis, we offer neurotized free muscle transfers and facial suspension. Cases of incomplete paralysis might also benefit from selective neurectomies or myectomies, or selective chemodenervation (e.g., Botox treatments).
Central hub for peripheral nerve
The OHSU Nerve Center is unique on the West Coast for our multidisciplinary approach to nerve disorders, assembling the collective expertise of OHSU providers in the fields of neurology, neurosurgery, orthopaedics, otolaryngology, pain management, physical medicine, plastic and reconstructive surgery, and trauma surgery.
When to refer
OHSU Nerve Center treats all nerve pain and injuries in the face, arms and legs. Patients receive a precise diagnosis for the best chance of recovering function and quality of life. Patients with the following conditions may benefit from an early evaluation for treatment:
- Acute onset of neuropathies with uncertain etiologies
- Brachial plexus injuries
- Congenital nerve disorders
- Facial nerve disorders
- Hand surgery for quadriplegic patients
- Nerve entrapment (carpal tunnel, cubital tunnel)
- Nerve tumors
- Painful neuromas
- Penetrating and blunt trauma nerve injuries
- Peripheral neuropathies
- Phantom limb pain
- Quadriplegic/tetraplegic hand disorders
- Spasticity in upper and lower extremities
- Other nerve conditions (amyloidosis, Lambert-Eaton myasthenic syndrome, Parsonage Turnersyndrome, spinal muscular atrophy)