Matthew's Story: A Healthcare Worker with COVID-related Arm Immobility Finds Relief Through Brachial Plexus Surgery

Matthew Bertoldi has been a Certified Nursing Assistant (CNA) for 20 years, after retiring from his former career as a classically trained chef. He worked in a nursing home in western Massachusetts when the COVID-19 pandemic began, and he contracted the virus.

Matthew's battle with COVID was long and arduous—he was in a hospital for six weeks, two of which were spent in the ICU. His doctors told him he was declared clinically dead twice but successfully resuscitated each time. Matthew eventually recovered enough to be discharged, but he was unable to move his right arm, so could not return to work. He spent a year and a half working with occupational therapists (OTs) and neurologists in his hometown to try and restore movement to his arm. After little progress, his PCP recommended he see a local orthopedic surgeon.

Finding Specialized Care for a Brachial Plexus Injury

After exploring several treatment options, Matthew's local orthopedic surgeon suggested that he had a brachial plexus injury. The brachial plexus is the bundle of nerves that connect the shoulder and arm to the spinal column and control movement and sensation in the bones, muscle and other tissues of the arm. Some brachial plexus injuries and neuropathies respond to physical therapy over time, but Matthew was part of a subset of patients who fail to improve significantly. Matthew's doctor referred him to Rohit Garg, MBBS, in the Hand & Arm Service at Massachusetts General Hospital. Dr. Garg specializes in treating brachial plexus injuries, and has recently worked with colleagues Dafang Zhang, MD, orthopedic surgeon at Brigham & Women's Hospital, and Bassem Elhassan, MD, co-chief of Mass General's Shoulder Service, to formalize this specialized focus across the Mass General Brigham system by creating the Mass General Brigham Brachial Plexus and Nerve Disorders Program.

Brachial Plexus Surgery to Restore Arm Movement

At Mass General, these three doctors conferred on Matthew's case to plan how to restore strength and movement in his right arm, especially at the elbow and below. The team were familiar with several cases of COVID-related brachial plexopathy, where patients develop neuritis (nerve pain or numbness) after COVID infection. In this case, the symptoms likely resulted from a combination of positioning (prone position in ICU) and possible neuritis related to COVID. They suspected Matthew had compressive neuropathy and scarring of the brachial plexus and recommended surgical exploration and neurolysis, which are surgical procedures designed to release scar tissue and create more space around the nerves.

On November 9, 2022, Matthew underwent brachial plexus surgery with Drs. Garg and Zhang. They performed an exploration of the brachial plexus with scar release around the brachial plexus in the neck and shoulder, along with release of the pectoralis minor muscle to increase space around the nerve. The team also performed release (opening up of space) around the most common areas of nerve compression in the arm: behind the elbow and in the forearm and wrist. In addition, after releasing scar tissue and giving the nerves more space, they performed direct electrical stimulation of the freed nerves. Though his care team suggested he might be cleared for discharge that same day, Matthew stayed overnight just to be safe, given his age, the number of incisions and other comorbidities. Post-surgically, he recalls feeling some arm tingling, but an almost immediate return of feeling and mobility in his arm.

A Chef Returns to the Kitchen

Matthew describes his experience with brachial plexus surgery as "miraculous." He has small incision scars on his arm and shoulder where the surgeons operated, but otherwise his recovery was swift and the results almost instantaneous. Dr. Garg adds that Matthew's results were exceptional; often, the recovery process is gradual and prolonged for brachial plexus patients. Matthew once again has the use of his right arm. Since he is right-handed, he regained the ability to dress himself, tie his shoes, hold his phone comfortably and perform other everyday tasks.

For Matthew, his regained mobility is most striking in the kitchen.

"I can cook again! I missed being able to use a French knife, and now I’m back, cutting onions, lifting a roast. I do all the cooking for my wife and I, and it was hard not having that creative outlet these past few years," he says.

Matthew is still healing, and he attends occupational therapy near his home on a regular basis. He has met with Dr. Garg following surgery for follow-up appointments to monitor his progress, and Dr. Garg expects him to be fully recovered within the year. Matthew doesn't plan to return to his work as a CNA, but he is happy to be home with his wife and feeling normal again. He is forever grateful to Dr. Garg and his team for restoring function in his right arm and, as a result, giving him his life back.

The Mass General Brigham Brachial Plexus and Nerve Disorders Program leverages the expertise of hand, arm and shoulder experts in orthopedic surgery, neurology, plastic surgery, and physical medicine and rehabilitation from the best-in-class academic medical centers that comprise Mass General Brigham. The clinical team treats all conditions affecting the bones and tissues of the arm and shoulder and are happy to consult with patients and offer second opinions. They can be reached at brachialplexus@partners.org.