When I was recruited to join the faculty of the Peterson Hand Center at Washington University Orthopedics, I was thrilled - and for good reason, as it is one of the premier orthopaedic hand surgery divisions in the world. I immediately told several friends and colleagues from around the country, who shared my excitement, then asked a followup question - what was my area of subspecialty focus? When I would enthusiastically reply "brachial plexus surgery", I was sometimes greeted by an interesting response - a quizzical look with a subdued shade of pity, paired with "Oooh... Why?"
Although I hardly agree, I can certainly understand why some surgeons do not want to treat patients with brachial plexus injuries - the circumstances are often unfavorable; the surgeries are long, tedious, and can be exhausting; and the outcomes are far from certain. Interestingly, these are some of the same things that I love about treating patients with brachial plexus injuries. From a purely "medical" perspective, I love the challenge of diagnosing the exact injury, figuring out the best treatment plan, seeing the breathtaking anatomy, and performing a surgery that intimidates others. But to be honest, the most rewarding part of it all is when the patient realizes the surgery has worked. After months and sometimes years of being told that they won't be able to use their arm at all, going through a ton of tests and doctors visits, and summoning up the courage to go through a long surgery (sometimes two or more), the patient can feel that things are getting better and that their motion and strength are improving. While this improvement certainly occurs over a long period of time, that initial feeling alone is enough to inspire hope and begin undoing months of pessimism and second guessing. I will never forget the ecstatic impression of my first patient who regained motion in his fingers after a tough nerve injury with a less-than-certain prognosis, and I can guarantee that the feeling never gets old for me. So that look - the initial, unfiltered "wow, that muscle is working!" look - that is why I love treating patients with brachial plexus injuries.