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September 7, 2022

He suddenly couldn't lift his fingers. What was wrong?

Daily Briefing

    When 29-year-old Michael Brenner was suddenly "unable to lift or extend his fingers" in his dominant hand, doctors across multiple specialties told him "they hadn't seen anything like it," Sandra Boodman writes for the Washington Post.

    Slide deck: Musculoskeletal health trends for 2022

    'Who wakes up and their hand doesn't work?'

    In June 2021, Brenner attempted to type a note on his computer and discovered he was "unable to lift or extend his fingers" in his dominant hand, Boodman writes. In addition, he noticed that his hand "felt inexplicably stiff."

    "I thought, 'This is really weird. Who wakes up and their hand doesn't work?'" Brenner recalled.

    Initially, Brenner assumed that his condition would be easily diagnosed and treated. However, over the course of 10 months, he consulted multiple doctors across several specialties, including an orthopedic hand surgeon, a physiatrist, a medical doctor who specializes in physical rehabilitation, a neurosurgeon, and a plastic surgeon.

    "I had become very open to the idea that I was never going to know what was wrong," Brenner said. "Most doctors told me they hadn't seen anything like it."

    When Brenner initially sought treatment, he went to his internist, who suspected damage to his radial nerve.

    The internist referred Brenner to an orthopedic hand surgeon, who asked him to lift his right wrist—which moved to the left—and to make a "thumbs up" sign—which he could not do. The surgeon told Brenner he had deep radial nerve palsy and ordered an ultrasound that found a large, unidentified mass that was compressing his radial nerve.

    Then, when the surgeon ordered an MRI, there was no sign of one. His radiologist suspected a condition called posterior interosseous nerve syndrome, which occurs when part of the radial nerve is pinched.

    To remove pressure on Brenner's nerve, the hand surgeon recommended a procedure known as radial tunnel release.

    When the surgeon operated on Brenner in July 2021, he told him his nerve was "extremely compressed," but said he should start to improve with physical therapy (PT), Boodman writes. 

    'I realized I needed a whole new medical plan'

    In Nov. 2021, after four months of PT resulted in little improvement, the hand surgeon referred Brenner to a physiatrist for electromyography (EMG) and a nerve conduction study to determine how well his nerves and muscles were functioning.

    Halfway through the EMG, the physiatrist left the exam room to check a textbook. When he returned, he told Brenner that he found nerve damage in his radial nerve where the surgeon did not operate during his first surgery. In addition, the physiatrist told Brenner he would likely need a second operation. 

    The hand surgeon then recommended that Brenner see a neurologist and get another EMG in 90 days. If the first surgery was unsuccessful, the doctor told him he would need a tendon transfer.

    "I was determined to learn all I could and to avoid it," Brenner said. "I realized I needed a whole new medical plan."

    When Brenner reached out to a neurologist, blood tests seemed to rule out systemic neurological problems or cancer. She told him she did not know what was causing his condition and referred him to neurosurgeon Allan Belzburg, chief of peripheral nerve surgery at Johns Hopkins Hospital.

    After Belzburg evaluated Brenner and reviewed his test results, he told him his symptoms were most likely the result of Parsonage-Turner syndrome (PTS)—a rare, poorly understood disorder also known as neuralgic amyotrophy. 

    Typically, Belzburg operates on PTS patients with plastic and reconstructive surgeon Sami Tuffaha, who agreed that a nerve transfer procedure was Brenner's best chance at recovery.

    However, when the surgeons started operating on Brenner, they discovered what seemed to be a severed nerve where his first surgery occurred. "Closer examination revealed a possible hourglass-like constriction, a rare deformity sometimes seen in PTS patients, caused by a band that tightly encircles the nerve making it resemble an hourglass," Boodman writes.

    Since neither of the surgeons had previously seen this, they reached out to Scott Wolfe of New York's Hospital for Special Surgery, who had performed a procedure called microneurolysis on similar patients.

    "We FaceTimed him into the OR, and he's looking at our microscope and we talked about what to do next," Tuffaha said. "Scott convinced us that microneurolysis should work."

    'I'm just not worried about him anymore'

    After a four-hour operation, Tuffaha said that while she hoped the procedure would work, she was still unsure. Unfortunately, Brenner's first follow-up EMG did not show any signs of nerve regeneration. However, his second follow-up EMG, performed just one month later, "detected the first flickers of activity," Boodman writes. As a result, Tuffaha was able to cancel Brenner's surgery.

    Since the second follow-up EMG, Brenner has shown "slow but steady progress," Boodman writes.

    "I'm getting better every week," said Brenner. "I'm at about 65 to 75 percent. I don't know that I'll get back to 100 percent."

    According to Tuffaha, Brenner could make a full recovery—but that could take 18 months. "I'm just not worried about him anymore," he added.

    In hindsight, Brenner said he wishes he would have seen a neurologist early on, which could have led to an earlier diagnosis. "I wish I'd had all the available tests done before that first surgery," he said. (Boodman, Washington Post, 9/3)

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