Hand Injuries

Baseball Finger
Brachial Plexus Injuries
Carpal Avascular Necrosis
Flexor / Extensor Tendon Injuries
Nerve Injuries
Proximal Interphalangeal (PIP) Joint Injury
Ulnar Collateral Ligament (UCL) of the Thumb


Brachial Plexus Injuries

Brachial Plexus is most commonly seen in newborns experiencing shoulder compression while passing through the birth canal during a lengthy delivery. Forceful pulling on their neck during an assisted exit may also result in a Brachial Plexus injury. Brachial plexus injuries most commonly seen in adults are generally the result of a traumatic injury such as that inflicted in a motorcycle or other high-speed motor vehicle accident. A fall from a great height may also result in this type of injury.

When the nerves exiting high in the neck are affected, the condition is called Erb's palsy and affects arm movement. And if both the lower and upper nerves are damaged, the condition is called Global palsy.

The four primary types of brachial plexus injuries include: an avulsion, the most severe form of brachial plexus, because the nerve is completely torn from the spine; a rupture, which is a torn nerve with no detachment; a neuroma, which is a damaged nerve that has tried to heal itself but developed scar tissue around the injury - causing increased pressure to the injured nerve and disrupting signals to the muscles; and neuropraxia, which is a stretch injury and among the most common type of brachial plexus injury, resulting in a damaged nerve that is not torn.

Risk Factors
Brachial Plexus is most commonly seen in newborns experiencing shoulder compression while passing through the birth canal during a lengthy delivery. Forceful pulling on their neck during an assisted exit may also result in a Brachial Plexus injury. Occasionally, other types of injuries causing restriction or compression to the vulnerable areas may result in this type of injury as well.

Diagnosis and Treatment
A hand that experiences loss of muscle control and becomes limp or paralyzed shows strong indication of nerve damage. Following a thorough patient examination, history and discussion of how the injury occurred, an electromyogram (EMG) or nerve conduction study (NCS) may be used to determine if nerve signals are present in the upper arm muscle.

While conservative treatment may be initially indicated, nerve surgery may be necessary if the affected nerves show no signs of healing followed by a period of splinting, or the condition is severe. These types of surgeries are most successful on children who are less than one year old.

For older children and adults, a tendon transfer is often performed followed by a period of casting and then splinting. Physical therapy is important in the recovery of any injury, but particularly when there is a period of casting because muscles that are immobilized quickly deteriorate. A specific rehabilitation program helps restore strength and re-establish normal hand movement.