Q: I am a 32 years old man and I had a major bike accident 3 years back in, which I lost the functioning of my right hand. I feel a burning sensation inside my hand as I am still having the blades inside the hand. How can this burning sensation be treated? I have been suffering a lot since the past 3 years. The doctor gave me pain relieving tablets, but they were of no use. I cannot move my right hand without the help of the other hand. Please advise.

A:From what you are describing you seem to have a brachial plexus injury. Though you have not mentioned anything about your diagnosis I can only think of this as the cause of your symptoms. Brachial plexus injury can be quite troubling and in addition to the paralysis that causes inability to move your finger, wrist it also causes significant loss of sensation. The degree of loss depends on the number of nerves involved. At the time of injury if the nerves are significantly damaged especially the sensory components (that part of the nerve that helps you feel touch, pain, pressure, temperature, sensations). The patients can have what is known as causalgia this presents with a burning, stabbing type of pain and this usually lasts for a very long time. Some patients come pleading for amputation but amputation does not help. Because the cause of pain is not in the hand it is in the injured nerve at a higher level but your brain reads it as pain in the hand. Unless the symptoms are tackled from the site of nerve damage nothing will help you. The assessment for this has to be very carefully made because the site of pain diagnosis is very critical for treatment. If the site is in the forearm or the arm, it can be explored and the nerves that are damaged and stuck to surrounding structures could be released. At times some pain clinics give nerve blocks in the brachial plexus, which can help in some situations. This is usually done by anaesthesiologists (who normally run pain clinics). Ordinarily exploring the nerves at the junction of the shoulder and neck where there is a network nerves called the brachial plexus is undertaken in the early phases of injury not after 3 years as in your case. In very severe cases some neurosurgeons do what is called dorsal rhizotomy a technique in which only the sensory nerves through which the burning pain sensation are carried to the spine and then to the brain are cut. Surgery is only for pain relief and nothing else. This is a technically demanding surgery done by neurosurgeons only in specialized centres and you cannot promise consistent results. I would recommend you show to a neurosurgeon who can then guide you on further management. Otherwise, you could get an orthopaedic surgeon who is familiar with this kind of injury. Decision will have to be made based on their assessment only.