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 such as burns. 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.
We looking forward to helping you live a more pain free life. Dr. Knight is one of the top hand doctors in Dallas. Visit Dr. John Knight at our Southlake hand and wrist center or Dallas office location.
Nerve Injuries of the Hand Fact Sheet
|How is it possible to injure the nerves in the hand?
|Nerve injuries to the hand can be caused by several different kinds of trauma, such as laceration or crush injuries. Overuse or repetitive motion is also a common cause. Conditions like Carpal Tunnel Syndrome are a type of nerve injury.
|Are nerve injuries to the hand something I can treat at home on my own?
|It is not advisable for nerve injuries to be treated at home. While some may not require as much medical intervention, all do need some, and having a doctor leading the treatment of your nerve injuries will give a higher likelihood of success.
|What types of medications can be used to treat nerve injuries of the hand?
|Nerve injuries can be treated with painkillers, in order to relieve the discomfort that often occurs, as well as anti-inflammatory medications if the surrounding tissues are responsible for the problem. In more severe cases, steroid injections may help relieve pain and swelling as well.
|Will the effects of the nerve injury to my hand ever go away, or can they heal on their own?
|If left untreated, some nerve injuries are capapble of healing themselves, but the majority require medical intervention in order to resolve. Nerves are delicate threads that carry very important information from the brain to the body, so letting them heal on their own can be a dangerous prospect without a doctor's oversight.
|If I injure the nerves of my hand, what kind of treatments can I expect?
|Nonsurgical treatment of nerve injuries can include rest, splinting, icing, and physical therapy. If the nerve has been severed, then surgery will be necessary to rejoin the disconnected ends and restore function and feeling.
Frequently Asked Questions:
Can nerve injuries heal themselves?
If the sheath in which the nerve resides is not damaged by whatever trauma injures the nerve itself, then there is a possibility of non-surgical treatment of the condition. This requires careful therapeutic work in order to retrain the nerve to speak to the brain and vice versa, and this can take time, but in order to avoid surgery, steps must be taken.
Can painkillers cure nerve pain?
While painkillers can be effective in reducing the pain that often accompanies nerve injuries to the hand, they are not a permanent solution, and overuse of most anti-pain medication can lead to dependence and a strong likelihood of abuse and addiction. Neuropathy, or nerve pain, may be quite severe when the injury is first acquired, but if proper medical treatment is sought and acquired, then repair to the injured nerves is a far more effective and permanent solution to the damage you have received.
What are symptoms of nerve damage in the hand?
Symptoms of nerve damage in the hand can vary widely depending on the type of injury that you receive affecting the nerves. in the case of crush or pressure injuries, or when the nerves are compressed, as in the various Tunnel syndromes, numbness and tingling are the primary symptoms, accompanied at times by pain in the fingers. Other forms of nerve injury can result in tingling, burning, loss of sensation, hypersensitivity, and phantom pains as a result of the nerves not communicating properly with the brain and the feeling centers.
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