typing with both hands
healthIf you’re here because you’ve just lost your radial nerve and you’re trying to figure out “what’s next” — I’m sorry. That genuinely sucks.
Eight years ago, with my left hand and my right index finger, I was Googling “severed radial nerve recovery”, “broken humerus nerve recovery”, and “how much does a new right hand cost on black market”. I got some personal videos, World War 2 stats on nerve growth (~1mm/day), and a few clinical studies that were, not inspiring.
Given the title of this post, I kinda spoiled the punchline… This post is what I wish I found then. So, here’s what happened, what I did about it, and how it turned out.
The bike
I bought my first motorcycle back in 2014 and I was a menace. 😅 Jakarta is a lot of fun on a motorcycle (very scary to drive a car here!) because the drivers are used to bikes, bajai, rickshaws, the works. I’d say it’s bike friendly (more so than Bali). I got a brand-new Kawasaki Ninja 250R, the gold standard “starter” bike with 26hp at the rear wheel. I didn’t want to go too fast, I needed to look cool AF. So, I handed it over to Studio Motor to turn it into a café racer. Stylistically, they did a good job and they introduced a ton of mechanical issues modified it.
I thought it looked cool; occasionally, I took photos of it… I took the photo on the right just ten minutes before the accident:
The accident
On March 24, 2018, I was riding home too late, had a bit too much to drink, and I parked the bike in the back of a truck. I’ve gone back and forth as to whether I should mention the drinking… I’m including it because maybe someone else can learn a bit from this.
I wasn’t drunk… but I learned that’s not the point. Each drink lowers your inhibitions (read: you’re more likely to speed) and your reaction time slows. Both, together, quietly. So when you come around a corner you’ve taken a hundred times and you find a fucking truck parked in the middle of a three-lane road (with the leftmost lane blocked by their construction), you wake up on a stretcher. Or you don’t wake up. 🤷♂️
I’ll never forget waking up on that stretcher. My nose itched. I went to scratch it with my right hand. My arm went up. My hand stayed there. You can see my hand was strapped down; I didn’t know that when I went to scratch that itch. I think I got my humerus to a ~30° angle before I was like, “oh shit.”
The damage: a chipped chin, 3 slightly cracked vertebrae, and a closed fracture of the right humerus. Those first X-rays are from RS Fatmawati. I don’t know why I was taken to a hospital so far away from the accident.. Sylvia arranged a private ambulance to transfer me to RS Medistra because I was going to need surgery and they have top-notch orthopaedic surgeons. Mohan snapped a few photos along the way:
Surgery: round one
Two days later, Dr. Kiki Novito, Sp.OT(K) rebuilt my humerus with a ~4 gram titanium plate and eight screws:
Dr. Kiki did a great job with the reconstruction – later, Dr. Sandeep praised Dr. Kiki’s work and told me horror stories of performing follow-up surgeries on patients to find plates on top of the radial nerve, crushing it against the bone. 😬 It’s clear that Dr. Kiki was mindful of this because, when I woke up after surgery, one of the first things he asked me to do was raise my right hand – I couldn’t. He assured me that was pretty normal: ~15% of people who break their humerus damage their radial nerve, and 90% of those recover on their own within a few weeks… I had to wait.
Research mode
Back at home, it was time for me to catch up on anatomy…
Turns out, the radial nerve connects to the muscles on the top of your arm (just past the elbow). Those muscles pull tendons that extend your hand – lift your wrist, straighten your fingers, give a thumbs-up. Disconnect the radial nerve and your wrist drops. You can still squeeze your hand, pulling your fingers in. You just can’t lift your wrist against gravity or open your hand.
Management of nerve gaps: Autografts, allografts, nerve transfers, and end-to-side neurorrhaphy - PMC is an approachable introduction to nerve injuries / repair. While radial nerve injuries are relatively common, I was disappointed to find only 6 case studies:
| Study, year | Patients | “Good”, M3+ | Normal, M5 |
|---|---|---|---|
| J Neurosurg, 2016 | 13 | 5 | 0 |
| Interfascicular grafting, 2011 | 35 | ~27 | 7 |
| Nerve grafts, 2007 | 23 | ~21 | 4 |
| Cable grafts, 2006 | 2 | 2 | 2 |
| Sural grafting, 2008 | 6 | 5 | 2 |
| Radial lesions, 1996 | 20 | ~14 | 4 |
| Total | 99 | 74 (74.7%) | 19 (19%) |
| MRC | What it means |
|---|---|
| M0 | Nothing. No contraction at all. |
| M1 | A flicker. The muscle twitches but moves nothing. |
| M2 | Moves, but only with gravity taken out. |
| M3 | Moves against gravity. The bar for a useful hand. |
| M4 | Moves against gravity and resistance. |
| M5 | Normal strength. |
Three of those studies didn’t provide detail beyond Medical Research Council (MRC) grade M3, “good”.
I wasn’t looking for “good”; I wanted to understand what my odds of “normal” were… Not all the studies recorded the M5 rate, so I extrapolated from the studies that did to the whole. That means only: 4 out of 21 patients, or 19%. On that basis, roughly 19 of 99 got all the way back to normal. 😬
Discovering those stats, with a wrist that couldn’t extend, didn’t feel “good”. It felt like I had an 80% chance of failure. 😭
Ann found Dr. Sandeep
Ann’s research was more fruitful. She found Dr. Sandeep Jacob Sebastin in Singapore – head of Hand & Reconstructive Microsurgery at the National University Hospital. I met him about a month after the accident and he laid out the fork in the road:
Tendon transfer: The surgeon takes wrist tendons and moves them from wrist down to wrist up. Reliable, fast. But it’s rewiring the plumbing, not the wiring: you don’t get your muscle back, and you have to relearn how to use your own hand.
Nerve grafting: You harvest an expendable nerve – in this case, the sural nerve, which runs down the back of the calf. The sural nerve is used because it only handles sensory input from the outside edge of your foot; no motor skills are lost. It’s pretty useless. You take the sural nerve, cut out the bad radial nerve, and bridge the gap… giving the radial nerve a fresh pathway on which to grow. Then you wait as the nerve grows.
Dr. Sandeep wanted to do the graft; if it failed, we could still do the tendon transfer later. But, first, he wanted to give the nerve a chance to recover. Dr. Kiki had seen that it was bruised, maybe partially punctured, but still connected.
The tests that ended the wait
Week six, in Jakarta: radial motor amplitude zero on both segments. Interestingly, the radial sensory fibres were still firing – degraded, but alive – which is a hint that the nerve was structurally continuous. Median and ulnar motor nerves were normal.
I remember this exchange with the doctor doing the test – not Dr. Kiki:
“That’s OK — you’re left handed, right?”
“No.”
“You are now!”
Burrrrnnnn. To be fair, it wasn’t a bad joke. I’d probably have made it too.
Surgery round two: the graft
On June 21, 2018 – 12.7 weeks after the accident – Dr. Sandeep opened my arm again and cut the damaged segment out. He even took photos for me:
Four parallel strands of borrowed nerve, each about 8 cm long, spliced in roughly 20 cm above the outside knob of the elbow. One detail worth highlighting: Dr. Sandeep re-routed my radial nerve above the muscle. To quote a presentation he made on the surgery:
Don’t put the graft on bare bone / plate. Bring it subcutaneously if required.
So my radial doesn’t sit on top of a titanium plate (with screws); he routed it up and out, under the skin.
A week later, my sister Ann – the registered nurse who found Dr. Sandeep in the first place – took the dressings off. Three incisions: the long one down the back of my arm, one at the calf, and one at the ankle where the sural nerve came out like spaghetti.
That ankle scar is the entire price of the donor nerve: a patch of numbness on the outside of my foot that I still have and never think about.
Typing again
Medistra had given me a standard wrist brace. It held my wrist up fine — but not my fingers, which made the brace pretty much useless. At my post-surgery follow-up in Singapore, about five months after the accident, NUH introduced me to the Mediroyal NRX ManEx Radial and custom-fitted it to my hand. It was a game changer. I went from typing with one hand and one finger to typing normally. I was/am dumbfounded that Medistra hadn’t introduced me to this device… if you’re currently wrist dropped, get one!
Going from six-finger typing to ten is a 66% WPM improvement! That new brace gave me hope… that even if the radial nerve didn’t innervate, I could live a normal’ish life again – all for only SGD $100. I put the brace on just now to type this sentence… first time in eight years, weird nostalgia, it smells… taking it off.
On the “improve the odds” side, Dr. Sandeep and I discussed all options that could plausibly help a nerve grow faster. Electrical stimulation? Possibly useful; I bought a TENS unit.
Additionally, Dr. Sandeep mentioned (paraphrasing):
There’s a Brazilian study that is testing high-dose testosterone effects on nerve regen..
Let’s do it!
Woah, I didn’t expect that enthusiasm, there are some side effects..
I’m not going to be in the Olympics, I’ve seen Pumping Iron. Let’s do this!
I was perfectly happy for my 1mm-a-day race to be officiated by the Enhanced Games. 😅 He wrote me a year-long prescription to steroids; I wish I documented specifically what he gave me, whoops. It definitely gave me a bit of oomph. Whether it did anything at all for the nerve, I have no idea. 🤷
Watching a nerve grow
Measuring my arm, referencing that WW2 1mm-a-day baseline, it looked like I had ~250 days to wait. Meanwhile, I could track the nerve regrowing, from the outside, by tapping on my arm. That’s because leading edge of the nerve is raw and “excitable”; so, tapping it on the forearm sends a signal to my brain that is normally coming from the hand… and my arm tingles, it’s kinda weird. Apparently, that’s called the Tinel’s sign. For months, that was the only evidence anything was changing.
Dr. Sandeep gave me three milestones to track: to the wrist extensors, to the finger extensors, and to the thumb extensors. The Case #1 is from the 2006 cable-graft report, the only paper I could find that published dates:
| Date | Day (≈ mm) | Expected | Mine | Case #1 |
|---|---|---|---|---|
| Mar 24, 2018 | −89 | Closed humerus fracture. Overall: 1 fracture, chipped chin |
Open humerus fracture. Overall: 4 fractures |
|
| Mar 26, 2018 | −87 | Humerus orthopedic treatment. Titanium plate, 8 screws |
Intramedullary nailing | |
| Jun 21, 2018 | 0 | Sural Graft 12.7 weeks after Accident ~ 20cm proximal to lateral epicondyle 4 cables x 8cm |
12 weeks after Accident ~ 25cm proximal to lateral epicondyle 3 cables x 11cm |
|
| Sep 14, 2018 | 85 | Around this time I could tap and feel shocks mid humerus. | ||
| Nov 1, 2018 | 133 | Around this time I could tap and feel shocks above the elbow. | ||
| Nov 8, 2018 | 140 | Reaches the brachioradialis — the muscle that bends your elbow with the thumb pointing up | ||
| Dec 13, 2018 | 175 | Reaches the wrist extensors — the muscles that cock the wrist back | ||
| Dec 25, 2018 | 187 | Around this time I could tap and feel shocks ~ 1 inch after the elbow. | ||
| Jan 2, 2019 | 195 | Reaches the supinator — turns the palm face-up | ||
| Jan 25, 2019 | 218 | Around this time I could tap and feel shocks mid forearm. | ||
| Feb 4, 2019 | 228 | Reaches the finger extensors — straighten the fingers | ||
| Feb 15, 2019 | 239 | Initial contractions of the radial wrist extensors Can kinda lift my hand, but not sure if it is from the wrist extensors.  |
||
| Feb 25, 2019 | 249 | Wrist can go to parallel against gravity. | ||
| Mar 23, 2019 | 275 | Reaches the thumb extensors — lift the thumb | ||
| Mar 28, 2019 | 280 | 40 weeks after Graft | Initial contractions of the radial wrist extensors 40 weeks after Graft |
|
| Apr 13, 2019 | 296 | Wrist extensor strong enough to type / 90% range of motion, no fingers. | ||
| May 11, 2019 | 324 | Fingers starting to extend, cannot lift straight up, but can hold flat out. | ||
| Jul 12, 2019 | 386 | Fingers can lift above flat, index & pinky are a bit sleepy. | ||
| Aug 11, 2019 | 416 | Index & Pinky above parallel but not as high as the others, no thumb action. | ||
| Aug 29, 2019 | 434 | 62 weeks after Graft | Maximum motor recovery 62 weeks after Graft |
|
| Early Sep 2019 | ~440 | Maximum motor recovery. No spreadsheet entry — but photos from around here show me using the hand normally, without thinking about it. |
Three things fall out of that table:
I expected movement sooner. The nerve was due at my wrist extensors around day 175, and Tinel’s sign tracked that well. But the first real contraction came at day 239 — about two months late. A nerve reaching a muscle isn’t the same as the muscle working: it has to reconnect, then relearn.
I beat Case #1! Maybe it was the roids. 😅 Their wrist extensors fired at day 280; mine at 239, six weeks earlier. Shorter graft, shorter gap, closed fracture instead of open — or luck. 🤷
The graft was June 2018 and the first twitch didn’t come until February 2019. Eight months of nothing but a zing moving down my arm. If you’re a few months post-op and terrified because nothing is happening; patience. 🙏
Where I landed
It’s been eight years. My right hand is at about 98% – call it M5. I type all day, with both hands, as advertised. I lift, I ride again (slower), I do pull-ups… Shake my hand and you’d never know. There’s a faint numb patch on the outside of my foot where the sural nerve used to be. In 2018, I wasn’t sure I’d ever use this hand normally again. 🥲
If you’re the person at 2am
- Those statistics are old, grafting keeps getting better. The papers above span 1996 to 2016. Add me as the hundredth patient, an M5. I’m the newest data point (in that set) and the technique keeps getting refined.
- Find your Dr. Sandeep! Someone whose actual subspecialty is nerve work. I’ll be grateful to Ann and Dr. Sandeep for the rest of my life.
- Get the brace. Specifically one that holds your fingers up, not just your wrist.
- Ask your doctor about “roids”. Why not? Maybe it helps. Good excuse, no?
Good luck!