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Surgeon Repairs Trauma Injury From Hawaii Surf

From the Washington University Record, January 25, 2007
By Beth Miller

Last July, Tim Russell and his family were enjoying a trip to Kauai, Hawaii, hiking, surfing and enjoying the sunshine. While bodysurfing in a remote area, Russell caught a wave. Then a wave caught him — slamming his head against the sand. When he came up for air, he had lost control of his arms and couldn't swim.

Six months later, Russell can lift his arms overhead and out to the side with little or no pain thanks to the surgical expertise of Susan E. Mackinnon, M.D., the Sydney M. Jr. and Robert H. Shoenberg Professor of Surgery and chief of the Division of Plastic and Reconstructive Surgery. But it was a long haul to get there.

While waiting for rescue after the powerful waves knocked him underwater, Russell said he had a very peaceful feeling.

"I thought, 'This is how I am going to die,'" Russell said. "The force of the waves was unbelievable — I guess I should have known when there were no Hawaiians in the water."

Russell's youngest daughter, 17, rescued her father and pulled him to shore. Russell realized he couldn't move his arms or head because of severe pain in his neck. Because they were in a remote area and their cell phones didn't work, they hiked the two miles back to the trailhead, which took more than two hours. Luckily, an ambulance was already at the trailhead due to another injury. It whisked Russell to the nearest hospital, where he had numerous tests for a spinal injury. The emergency department physicians wanted to send Russell to Honolulu for spinal surgery.

"I told the doctors that if I had to have surgery, I was not having it in Hawaii — I was going home," Russell said.

Once home in Nixa, Mo., Russell went to see neurosurgeon Robert Strang, M.D., who wisely wanted to wait before doing surgery to determine if it was truly a spinal injury. An electromyography, which measures the electrical discharges produced in muscles or nerves, showed that it wasn't a spinal injury but a trauma injury to the brachial plexus, a network of spinal nerves that begins in the back of the neck, extends through the armpit and conducts signals from the spine to the shoulders, arms and hands.

From the time of his injury until his Nov. 27, 2006, surgery, he was unable to work and his wife, Marcia, had to help him bathe and dress.

Russell's neurosurgeon referred him to Mackinnon, who found that Russell's suprascapular nerves, which branch from the upper trunk of the brachial plexus, were trapped, causing his pain and weakness.

"The suprascapular nerve is a small nerve that travels through a very tight tunnel at the top of the shoulder blade," Mackinnon said. "While the cause of Mr. Russell's nerve entrapment was unique, there are probably a lot of people with shoulder pain and dysfunction who have a similar, unrecognized problem that has come on more gradually.''

Mackinnon performed surgery at Barnes-Jewish Hospital to release the pressure on the suprascapular nerves by cutting the ligaments, which cover the nerve and run through a notch at the top of the shoulder blade. "The hit from the wave tugged on the nerve and caused enough swelling at that suprascapular tunnel to compromise the blood flow to the nerve," Mackinnon said.

Two days after surgery, Russell reported no numbness in his hands or pain in his arms and that he could see an increase in mobility.

"When I first saw Mr. Russell, he was walking like a penguin without any function in the shoulder muscles," Mackinnon said. "When I saw him just a few days after surgery he told me that for the first time since the accident he could get his arms above his head to wash his hair. We were both thrilled."