Nerve Injuries of the Hand
What are nerve injuries?
The hand is a very delicate and precise instrument, made up of various networks of blood vessels, muscles, tendons, ligaments, bones and nerves. The nerves are arguable the most important of these, because it is nerves that allow us to use our hands to feel, and touch is the most important aspect of the hands. It is nerves that allow the sensations we feel with our hands to be transmitted to the brain. Like the other systems in the hand, the nervous system is prone to injury due to the makeup of the hand, and these injuries can be debilitating to the use of the hands.
What causes nerve injuries?
The nerves of the hands are susceptible to several different types of injuries, including pressure injuries, stretching injuries, and cutting injuries. Pressure and stretching injuries do not physically sever the nerve, but can still impede their communication with the brain. Cutting injuries are tricky, because there can be various outcomes. Because the nerve lies within a protective canal, if the nerve is cut or broken, while the canal remains intact, it is possible that the nerve fibers will grow back eventually, but if the canal is also severed, then surgical intervention is necessary to repair the damage. Should the severed nerve not be repaired, then a neuroma, or nervous scar, can develop and these can be extremely painful.
Symptoms of nerve injuries
The primary symptom of nerve damage in the hand is loss of sensation, which means that heat, cold, and pain are not felt in the hand as they would be in the rest of the body, which can lead to severe injuries. Nerve damage can also cause intense sensation and pain, know as neuralgia. Muscles supplied by the injured nerve lose their electrical stimulus rendering them paralyzed.
Diagnosing nerve injuries
A detailed history and clinical exam is very important to determining what has been injured. Additional testing is a Nerve Conduction Velocity/EMG test, which allows the doctor to see how fast and how well signals are transmitted along the nerve to the brain. An MRI scan may be helpful in some cases, because they allow the doctor to look inside the hand and physically see the damages to the hand and verves without having to cut into it.
Non-surgical treatment of nerve injuries
As mentioned before, if the sheath that covers the nerve remains intact, the ends of the nerves farthest from the brain will die, but they will eventually grow back. In these instances, surgery is not necessary, but the healing process can be greatly helped along by therapy, which will both keep the joints and hands in optimum working condition and help reinvigorate the sensation of the hands. After loss of sensation or nerve death, often the nerve pathway “forgets” how to notify the brain, so it must be re-educated in this capacity. The muscles will be kept from atrophy through therapeutic stimulation.
Surgical treatment of nerve injuries
Surgery to repair nerve damage can progress in several ways. The first, and simplest, is simply to reattach the severed ends of the nerve sheath to one another, allowing for the injured nerve to die away and grow back as healthy nerve fiber within the sheath. This process can be delayed if the injury is the result of crush trauma, as the skin/tissues will have been damaged, and must heal before surgery can be performed. More invasive surgery is necessary if part of the nerve has been lost, and there is a gap between the two parts of the nerve. It is usually necessary to perform a nerve graft from another part of the body, but the loss of the nerve in that part will often cause permanent loss of sensation, so it is important to take part of a nerve that is not absolutely integral to the function of the body. In some cases a small gap can be bridged with a synthetic nerve conduit.
How can Dr. Knight help you with nerve injury?
It is important to quickly diagnose a nerve injury as the quicker you get this repaired the better the results. Dr. Knight has extensive experience in micro-surgery and nerve repairs. Through his attention to meticulous detail at surgery, your chance for return of feeling and function is high in Dr. Knight’s hands.
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