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PeteMC
11-12-2016, 09:12 PM
Hope someone can help with this - I'm still in Tudor-esque fantasy mode here, so no modern drugs / methods available (and no healing magic).

A character has taken a sword cut to the left shoulder, and I'm picturing it as being across the side of the deltoid. The description as I've written it is:

"It was that shoulder I was worried about. The cut was deep, right through the meat and almost to the bone. That’s not a killing place, not in itself, but if it went bad he’d be done."

They have shelter and access to a barber-surgeon, and I don't want the guy to die so the wound won't be going bad. I realise he's going to be laid up for a long time healing but is that arm ever going to work properly again?

c.e.lawson
11-12-2016, 09:40 PM
The main danger would be axillary nerve damage. Which won't repair if sliced through. And the sequelae of that can be permanent weakness and sensory loss.

https://en.wikipedia.org/wiki/Axillary_nerve_palsy

MaeZe
11-12-2016, 09:55 PM
The main danger would be axillary nerve damage. Which won't repair if sliced through. And the sequelae of that can be permanent weakness and sensory loss.

https://en.wikipedia.org/wiki/Axillary_nerve_palsy

Peripheral nerves can regrow if transected. If they couldn't then reattaching severed limbs wouldn't be very successful.

CWatts
11-12-2016, 09:57 PM
How much time does your story cover? A full recovery is possible, but it might take a year. Having him unable to raise his arm but able to use his hand and forearm sounds realistic. If he's a nobleman who won't ever have to do manual labor he'll be fine, otherwise he will be very concerned about earning a living.

I've researched the axillary nerve damage for a character with a deep graze (tangential) GSW and lingering numbness/weakness is common.

PeteMC
11-13-2016, 12:18 AM
Thanks guys.

There's not going to be any re-attaching severed nerves with 15th century(ish) medicine I wouldn't have thought, so I guess he's going to be in bad shape for a good year or so then. That's really helpful as always, cheers!

King Neptune
11-13-2016, 03:27 AM
Thanks guys.

There's not going to be any re-attaching severed nerves with 15th century(ish) medicine I wouldn't have thought, so I guess he's going to be in bad shape for a good year or so then. That's really helpful as always, cheers!

Make a year, if that's what you need, but it might bemuch less than that, because the severed ends can grow toward each other. It would take a few months, but that might be all.

MaeZe
11-13-2016, 03:31 AM
... because the severed ends can grow toward each other. ....Sorry, that's not correct. Severed peripheral nerves have to regrow from the top down. Nerve endings cannot re-fuse together.

King Neptune
11-13-2016, 03:36 AM
Sorry, that's not correct. Severed peripheral nerves have to regrow from the top down. Nerve endings cannot re-fuse together.

O.K., I was informed otherwise by someone who had the experience of a major nerve in his arm growing back that way, but that's not my specialty.

Roxxsmom
11-13-2016, 03:57 AM
Yeah, peripheral nerve axons separated from their cell bodies actually degenerate distal to the site of injury. However, if the neuron cell body survived (and it is going to be in the spinal cord, brain, or in a ganglion that's away from the site of injury, so it likely will have), it can regrow a new axon with help from the friendly neighborhood Schwann cells (they form something called a regeneration tube that attracts the regenerating axon tip along the correct path, occupied by the old, degenerated axon below the cut. This process can indeed take months. Having the two ends of the severed axons in close proximity is needed for the regeneration to proceed properly, however.

http://www.mhhe.com/biosci/ap/vander/student/olc/n-reading30.html

MaeZe
11-13-2016, 04:09 AM
O.K., I was informed otherwise by someone who had the experience of a major nerve in his arm growing back that way, but that's not my specialty.

Your friend may have a misunderstanding about the anatomy involved. A surgeon can sew the outer covering of the nerve together giving the nerve a pathway to regenerate into. Peripheral nerves have a cell at one end and an axon grows out from there. Only the side with the cell can regenerate, but the insulating cells are a different thing. (http://orthoinfo.aaos.org/topic.cfm?topic=A00016)


When a nerve is cut, both the nerve and the insulation are severed. Sometimes, the fibers inside the nerve break while the insulation remains intact and healthy. If the insulation has not been cut, the end of the fiber farthest from the brain dies. The end that is closest to the brain does not die. After some time, it may begin to heal. New fibers may grow beneath the intact insulating tissue until it reaches a muscle or sensory receptor....

The insulation around both ends of the injured nerve is sewn together. The goal in fixing the nerve is to save the insulating cover so that new fibers can grow and the nerve can work again.

King Neptune
11-13-2016, 04:20 AM
Your friend may have a misunderstanding about the anatomy involved. A surgeon can sew the outer covering of the nerve together giving the nerve a pathway to regenerate into. Peripheral nerves have a cell at one end and an axon grows out from there. Only the side with the cell can regenerate, but the insulating cells are a different thing. (http://orthoinfo.aaos.org/topic.cfm?topic=A00016)

That's what I suspect happened.

PeteMC
11-13-2016, 06:11 PM
Ok thanks - so it would be reasonable if he was pretty much back to normal after say six months, just from his own body's healing processes?

CWatts
11-13-2016, 09:37 PM
Ok thanks - so it would be reasonable if he was pretty much back to normal after say six months, just from his own body's healing processes?

That would depend on his definition of normal. If you mean a full range of motion in his arm and the ability to do everyday tasks like he did before, I'd buy it. But having him bounce back to the equivalent of a professional athlete's level of performance would take longer and he may never be the same. If say he is a warrior maybe he can't bring his shield around as quickly as he used to and so he has to adapt his fighting style to that reality.

Bond's recovery in Skyfall is a good example, where he was having difficulty regaining his marksmanship, etc.

c.e.lawson
11-13-2016, 09:40 PM
Peripheral nerves can regrow if transected. If they couldn't then reattaching severed limbs wouldn't be very successful.

When you reattach severed limbs, the surgeon also reattaches the nerves.

MaeZe
11-13-2016, 09:55 PM
When you reattach severed limbs, the surgeon also reattaches the nerves.

No, they do not, at least not yet. You cannot sew axons back together. See my link in post #10 above. They sew the insulating tube back together, the nerve has to regrow.

Putting Severed Nerves Back Together Again (http://www.asianscientist.com/2015/01/in-the-lab/putting-severed-nerves/)
A study in roundworms has uncovered the pathway required for the joining of severed nerves, prompting fresh research in regenerative medicine....

“Neurosurgery alone to fix nerve injuries by effectively trying to stitch together broken nerves has had limited success,” he said.

c.e.lawson
11-13-2016, 10:04 PM
No, they do not, at least not yet. You cannot sew axons back together. See my link in post #10 above. They sew the insulating tube back together, the nerve has to regrow.

Putting Severed Nerves Back Together Again (http://www.asianscientist.com/2015/01/in-the-lab/putting-severed-nerves/)

Who said anything about axons? Or the specific surgical micro-technique? My point is that surgeons need to reattach the nerves in order for a cleanly sliced severed nerve (which is what we're most likely discussing in a sword fight) to have any hope of recovery. And surgeons aren't performing this procedure in the OPs historical setting.

MaeZe
11-13-2016, 10:12 PM
Who said anything about axons? ...:Huh:

What do you think they sew back together?

c.e.lawson
11-13-2016, 10:29 PM
Oh good grief - we're talking in layman's terms here. Which is more easily understandable, and which I use with my patients in my clinical practice. Can a severed nerve from a deep sword cut spontaneously repair itself? No. It needs a surgical procedure to sew the 2 ends back together. And that can be with different techniques. Whether that's the "tube", or actually trying to match fascicular bundles end to end is not the point. And yes, there is a technique of direct suturing of fascicular bundles. The point is, in order for a transected nerve (by a deep sword cut) to recover function, it MUST be surgically repaired, and the OPs character is not going to receive any surgical intervention centuries ago.

AW Admin
11-13-2016, 10:41 PM
I think this thread has served it's purpose. Thanks all.