nerve damage from a crush injury

[liddie8888]

I was crushed and had all 12 ribs broke meaning both 1st ribs both shoulder tore 3 herniated dices in lower neck one in my lower back all the ribs are overlapped I have pain in my right arm that starts at the neck and runs down to my pinky and ring fingers also pain in my thumb burning all acrossed my back pain in my lower neck also pain in my lower back that runs down my left leg mainly but on occation goes to the right also I'm in pain 24/7 its dominating my life have been to neumorous doctors I want an honest opinion of what to bring to there attention of what to do for treatment ? signed please help me


This discussion is related to Neuropathic pain due to brachial plexus on the right arm.

[caregiver222]

I will expand a bit on the idea of "range of motion" exercises insofar as cervical nerve compression. Range of motion is initially contraindicated. That is to say initially, the protocol is rest and very moderate stress. After a period of several weeks, as long as the is not instability, the drill is reduction of inflammation and movement. The hard part is determining whether or not there is instability.  In the case of subluxion injuries, a lot depends upon the damage to the cartilidge, which goes to the heart of the decision regarding stability. If the cartilidge is totally destroyed, a surgical option may be necessary. Often the damage is moderate, and with relief of compression by means of axial traction, hydration, and reduction of inflammation, pain may be relieved or eliminated. The question arises" How long does one have to apply axial traction?" The answer is that these injuries may be life-long, and years later, every week or month or so when the pain starts, you have to get out the axial traction device and use it for s few minutes two or three times a day. You can do this at work. The devices come with a water bag, which you discard. There is a head strap that attaches to a horizontal bar that has a center hook. A rope attaches the center hook to a cup-hool in the opper beam of a doorway, for example. You place a chair underneath and adjust the rope so you are not "hanging" but that your head is pulled upward in a line with your spine....ever so gently. You will feel immediate relief from pain and numbness. Another key to the process is the use of intermittant axial traction. No more than an hour at a time. Five to fifteen minutes seems to work well. Excessive traction will result min loss of muscle tone, which is what you don't want. That is why cervical collars are not helpful.

[caregiver222]

I might add you also have what appears to a problem with Sciatica. There are excellent posts elsewhere on this problem. In Europe they have been successful in injecting the spaces between the vertebra with ozone, which is currently approved in only one state (Nevada). There are specific exercises that can help with this problem, as well as use of  TENS device before surgury is considered.

[caregiver222]

I am going to be in big trouble, because I am going to disagree with Dr Srivasta on this one.  A splint, as well as a cervical collar, is generally contraindicated. Not always.

The reason is that provision of such support causes loss of muscle tone, which agravates the situation.

The first issue to be addressesdis whether or not your cervical vertebra are stabilized. If they are not stabilized surgical intervention is usually considered.

The decision tree rests upon differentiating between a stabilized cervical spine and an unstabilized one.

If ther are, in fact stabilized, you have what is called a subluxion injury, which is treated by application ox gentle axial traction for short periods several times a day together with anti-inflammatories.

Axial traction devices provide a gentle pull to separe the vertebra, which allow the swelling and inflammation to simmer down and provide the nerve time to heal.

A typical protocol would involve initially from five-fifteen minutes of gentle axial traction eight times a day, every two hours or so with the number of periods gradually decreasing over a number of weeks. Often for the forst week a physician will prescribe prednisone, 60 my the first day and tapering down over a week and gradually shifting to an NSAID such as Ibuprufin, 800 mg a day in two equally divided doses with food. Good hydration with electrolytes is also necessary.

The axial traction devices sell for about thirty five dollars U.S. and are available without a prescription.

Ocasionally Metformin (the diabetic drug) is helpful, even though this is not an approved use. It affects osmolality, which is affected by high blood glucose levels. Eating small meals and avoiding sugar will help a teensey weensey bit.

Avoid riding in a car and if you do so think about an inflatable cushion.

One of the problems with this kind of injury is that the patient feels pain and "self-splints". Thus I am also going to disagree with the advice to avoid repetitive wrist movements. The problem is in the cervical area. Often what is prescribed are range-of-motion exercises through the limits of pain. This is contrary to all common sense.

This is where the issue of a stabilized vs a non-stabilized cervical segment comes in.

I do not recommend you adopt any of my suggestions without consulting a specialist (M.D.) in what are called subluxion injuries.

[Dr. A. Srivastava]

Thank you for your question. Although without being able to examine you I can not offer you the specific advice on diagnosis and treatment that you need, but I would try to provide you some relevant information about your health concern.

The symptoms you are describing are associated with impingement of nerve in which cervical nerve is impinged leading to numbness, tingling sensation or pain. I would advise an orthopedic consultation who may investigate the problem with help of X-ray or MRI of the cervical soine, hand to reach to a probable diagnosis and further treatment required as per the diagnosis achieved. The first line of treatment mostly involves a splint to stabilize the neck and needs to be worn at night or during the day for several weeks. Surgery may be successful in your case but suggested on severity and duration of nerve compression. Hot and cold compresses may also be helpful. In addition, avoid/reduce the number of repetitive wrist movements whenever possible. Hope this helps.