Long Term Issues:                

       Ageing and the effects of BPI

For someone who has recently had a brachial plexus injury, the symptoms of aging and their effects on a person with a completely or partially paralysed arm may not be top of the list of concerns in the early years. As time goes by, and the body ages, certain signs of the ageing process could be partially blamed on, or related to the BPI, particularly any new signs of  muscle weakness or strain.
At least some of this weakness, especially in older individuals, is probably a normal part of aging. It is estimated that a person will begin to lose about one percent of their motor neurons per year after the age of 60. This is not very significant if an individual starts with 100% of their motor neurons, and all are intact and undamaged. Unfortunately, this is not the case when the supply is depleted by the brachial plexus injury and this gradual loss will have a much greater impact. Studies on aging in disabled people generally have shown that the average time for other weaknesses or associated pain to begin is around 15 years post injury.  
Muscle weakness is often asymmetrical. This can put added stress on the entire neuromuscular system, as well as adding strain to joints and supporting ligaments. The result may be an increase in arthritis-like pain. Most of us are somewhat 'lop sided', this can result in imbalances causing other problems, sometimes nowhere near the BPI but caused by years of poor posture and excessive use of the unaffected limb. The classic BPI 'I can do anything!' mindset probably contributes to this and is of course a very positive thing, but we need to learn to listen to our bodies.  

If the new pain is debilitating, an individual should seek medical advice to rule out other possible causes for their symptoms a person who has a BPI is not immune from other, separate physical ailments. The new problem may well be BPI related, but it is unwise to make assumptions. A complete check up with your doctor, including a referral to an orthopaedic specialist if necessary, will help to clarify whether any symptoms are related to the BPI, and whether further treatment is warranted or whether rest will ease the problem.  Even if no immediate problem exists, this testing will provide a baseline for measuring your future status. It is important to remember that 2 out of 3 adults over 50 will suffer from arthritis, for instance, irrespective of whether they have a prior nerve injury.

Lifestyle modification is the most important therapy for new weakness. This will reduce the strain placed on the body. Learning to listen to the body's signals is vital to any plan designed to reduce further degradation of muscle strength. If you're tired, rest. If you hurt, stop. This is not always an option in individuals with a flail BPI arm, and overuse symptoms in the unaffected arm can leave such people helpless, without any arm to use at all. For this reason anything which causes pain in the good arm should be discontinued immediately, it is better to leave a task which places too much strain on the unaffected arm until another day when help may be sought than to risk not even being able to brush your teeth tomorrow! If any activity causes pain in days subsequent to the activity, rest will in most cases allow the arm to recover, and the activity should not be undertaken again. 

I started getting severe pain in my unaffected arm as the mother of a small child, it did seem at first as though there was no alternative to lifting the increasingly heavy (and often struggling) child but I did make a conscious effort to encourage her to do things without my help, such as climbing into her car seat, I got rid of her cot early to avoid lifting her out of it and now she is three years old I rarely lift her and my arm is as strong as ever. If I do need to lift her, I squat down with my knees bent and take a lot of her weight against my body to save strain on the arm. This has taught me a valuable lesson in not only modifying the things I do, but modifying how I do them to minimise injury to the unaffected arm. The old adage 'Use it or lose it' does not hold true for us, instead, we should use it, but with care. 
In researching this article, I found many websites etc about specific disorders a person with a BPI may suffer in years to come, such as scoliosis, tendonitis, arthritis, the list is endless. In the end I decided that the temptation for self diagnosis was too great, basically I fit ALL the symptoms of most of these conditions. I therefore advise anyone who is suffering new symptoms of pain or numbness anywhere in their body to visit their GP as a first point of reference, explain about the BPI and take it from there. 

And if it hurts....stop it! 


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