New Nerve and Tendon Surgery Restores Quality of Life for Young Mother

In September 2020, Jessi Wood, now 38, gave birth to her fourth child, Lizzie. In the midst of some complications following labor, she suffered a stroke that left her paralyzed on her left side. “I did not meet my baby until she was two months old, because I was in the ICU and then in inpatient rehab,” said Wood, who lives in Skippers, VA.

Eventually, Wood and Lizzie returned home to their family, but her paralysis persisted. Wood’s left elbow was contracted close to her body, and her hand was balled into a constant fist. She sought treatment at a local hospital, where a doctor used Botox to temporarily loosen her muscles. But it wasn’t a permanent solution, and she had to return every three months for more injections.

Around the same time, Duke Health orthopaedic and peripheral nerve surgeon Neill Y. Li, MD had been reaching out to doctors to see if they had any candidates for a treatment he was initiating at Duke. Wood’s doctor thought of her.

Wood’s doctor “told me that he didn't know a lot about the procedure because it was very new, but that Dr. Li completed a fellowship at the Mayo Clinic in Rochester, MN where he trained to perform cutting-edge procedures aimed at spasticity and was eager to bring it to Duke to help people around here,” said Wood. “It ideally would be a more permanent solution to the paralyzed and tight left arm, outside of intermittent Botox injections.”

Wood was determined, and made the two-hour drive to meet with Dr. Li. After examining her arm and conducting nerve studies, Dr. Li agreed that she was a good candidate for the procedure, called a hyperselective neurectomy with tendon lengthening.

“A lot of times, when someone has a stroke, there is a loss of inhibition from the brain that regulates reflexes and muscle contraction causing too much nerve activity going to the extremities,” explained Dr. Li. “That causes the nerves and muscles to be in a hyperexcitable state with exaggerated contraction and increased tightness. We can locate the nerves that cause those contractions, and selectively remove some of them so that there’s not as much signal going to the muscle, which makes it loosen. We can also further lengthen and reroute tendons to provide additional function.”

In September 2023, Dr. Li performed the outpatient procedure on Wood’s elbow. “Once you start taking these nerves away, you start seeing her muscle relax a little more, even during the surgery,” he said.

Next was working with Duke occupational therapist and certified hand therapist, Theresa Hallenen. At the same time, Dr. Li planned a second surgery to help with her hand. Wood’s work with Hallenen included strengthening the wrist and hand for surgery, stretching the left arm, and mimicking everyday actions, such as reaching.

“Theresa is really good at listening to me,” said Wood. “If I tell her I don't really particularly like a certain exercise or I don't feel a certain gain out of an exercise, then she adjusts it so that I feel it means more to me. That patient-centered care from her means a lot to me.”

“The patient is part of our team, and Jessi was a collaborator every bit of the way. Jessi worked hard in the clinic and at home to get the best possible outcome for her left arm,” said Hallenen.

In January 2024, Wood underwent her second surgery consisting of additional nerve and tendon procedures with Dr. Li. “That released my hand, so it's no longer closed and stabilized my wrist,” said Wood. “At my first appointment following that surgery, I looked at Dr. Li and said ‘I haven't seen my palm in three or four years.’ In the grand scheme of things, it's a big deal to see your palm!”

Jessi continued extensive therapy with Hallenen after the second surgery, including wearing custom braces, stretching, strengthening, and using the left arm for everyday activities. This allowed Jessi to have the confidence to use her left arm at home. She was able to hold toothpaste with her left hand, open the gate to her pool, and get a manicure.

While Wood continues to work towards regaining full control of her left arm and hand, the improvement has been life changing. “The other day, one of my kids said, ‘Hey, Mama, let's go outside and play’,” said Wood. “I thought ‘Oh gosh, I don't know if I can. I can't get a jacket on myself’. Then I was like, ‘I just did the surgery for this exact reason’, and I put the jacket on by myself. You want to talk about improved quality of life? That was huge for me, as a mom.”