A birth injury left him in agony. A complex surgery “changed everything”

Tyler Theroux came into the world with a brachial plexus birth injury that kept his left arm dysfunctional and contorted in pain. As a child, he couldn’t engage in playground activities like the monkey bars, and his classmates would bully him about the injury. 

Eventually, Theroux dropped out of school to be homeschooled. While the teasing stopped, the pain didn’t: His parents watched him experience fresh agony with every growth spurt. The brachial plexus is the group of nerves that sends signals from the spinal cord to the shoulder, arm and hand, and that nerve pain kept him awake at night, despite multiple attempts at surgery and therapeutic treatment. 

Despite the pain, Theroux, 27, did his best to live a normal life, supported by his parents and brothers. He went to college to study recreational therapy, so he could help people with injuries like his, but a bad fall on ice — worsened by his inability to catch himself — aggravated his pain to new heights. 

For two years, he was essentially bedbound from the pain. 

And, he couldn’t use his left hand because of a nerve condition called radiculopathy — leaving him depressed and easily exhausted, missing family milestones and more. He couldn’t lift his hand above his waist, making it difficult to even get dressed by himself or tie a pair of shoelaces. 

The deterioration in his condition sent his parents, Ken and Michelle Theroux, into a frenzy of research.

“It was very, very difficult,” Michelle Theroux told Business City News. “We were constantly searching for answers, which we didn’t have in our area, really. We tried every therapy under the sun … Anything anyone suggested, we would do. But it just seemed to get worse.”  

Business City News Why are brachial plexus injuries difficult to treat? 

Brachial plexus injuries are uncommon, and they can be caused in a number of ways. Brachial plexus birth injuries like Theroux’s occur in 2 or 3 of every 1,000 live births, according to the Cleveland Clinic. Brachial plexus injuries can also happen to older children and adults. About 70% of traumatic brachial plexus injuries come from traffic accidents, the Cleveland Clinic says, and the number of brachial plexus injuries diagnosed each year is increasing. 

Mild brachial plexus injuries tend to heal on their own, or with physical therapy, but in more severe cases like Theroux’s, surgery is required. However, surgeries are often complex, and may still not return the affected arm or hand to its uninjured state. Options for treatment include nerve repairs, nerve grafts or nerve transfers. 

“The peripheral nervous system is something that still remains very poorly understood,” Dr. Jacques Hacquebord, the chief of the division of hand surgery at NYU Langone and the co-director of the facility’s Center for Amputation Reconstruction, told Business City News. “It does produce a lot of dysfunction when it’s not functioning properly. It creates a tremendous amount of problems for patients, and when they have these problems, they don’t know where to go. There are people that do peripheral nerve surgery, but there are very few peripheral nerve specialists.” 

“Many times, these patients get passed around because people don’t really know what’s going on with them,” he continued. “Their problems are real, but we as a medical community don’t have the ability to fully describe their symptoms and describe the cause of their symptoms. It’s common for patients to come to me with desperation, like I am their last hope.” 

That was the case for the Theroux, who had already tried a number of treatments. He and his family expanded their scope outside of their native Canada after a panel of surgeons from a range of disciplines assessed Theroux and determined there “wasn’t anything they could do for him,” Michelle Theroux said. That assessment bolstered their belief that Theroux needed surgery out of the country, but now, they weren’t sure where to look — or how they might pay for care not covered by Canada’s publicly-funded national healthcare system.

“Tyler was at a spot where … there were no barriers that we were not going to get over,” Ken Theroux said. “We were prepared to sell our home and do whatever it took, financially, to do this.” 

Business City News A complex surgery provides “light at the end of the tunnel” 

When they began researching outside of Canada, the Theroux family found two surgeons at NYU Langone: Hacquebord, who specializes in treating brachial plexus injuries and other conditions involving groups of nerves, and Dr. Andrew Price, an orthopedic surgeon and clinical professor who focuses on treating brachial plexus birth palsy, the specific injury Theroux was diagnosed with. 

Working with the Theroux family, Price and Hacquebord came up with a surgical plan. They would perform both a supraclavicular neurolysis, which would treat the injured nerves, and a rotational humeral osteotomy, which would give Theroux more movement in his arm. 

“A few days after we had met with the doctors, Tyler was just weeping in the shower,” Ken Theroux said. “Michelle and I look at each other, we’re going like ‘What, is something wrong? Did he hurt himself?’ So I asked Tyler ‘Are you OK?’ And he said ‘Yes, everything just kind of hit that there is a light at the end of the tunnel.’ He had given up.” 

The surgery was delayed multiple times as the Theroux family worked with a consultant to have the surgery covered by the Canadian healthcare system, and finally, on December 5, 2023, the operation was underway. 

Theroux said he felt “kind of nervous” about the procedure, but Hacquebord said there were “no surprises” during the complex surgery. The supraclavicular neurolysis is targeted and precise, Price said, often done under a microscope. Hacquebord, Price and the surgical team removed scar tissue from Theroux’s nerves during that surgery and rotated the bones of his arm to increase movement during the humeral osteotomy. The combined operations took about four hours. Theroux said he felt relief right after waking up. 

“I immediately knew that the pain was mostly gone,” he told Business City News. “(The pain) went from a nine out of 10 to a two out of 10.” 

About nine months later, he continues to recover, moving more easily and making plans to return to college for the next academic year while continuing occupational therapy that gives him even more use of his arm. He’s able to play sports that he loves and even went to a summer camp for other people with brachial plexus injuries, an experience that he said helped him feel seen in a new way. 

“It’s just changed everything,” said Michelle Theroux.

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