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


Nerve Injuries

Part of an intricate network responsible for carrying messages from the brain to the rest of the body, nerves are an essential part of body function. From lifting a finger, to moving a hand off a hot surface, nerves make it possible to react when the brain indicates.

The three main nerves affecting hand, finger and thumb movement include the radial, median, and ulnar nerves. The nerve fiber and its insulation are fragile and often damaged by excessive stretching, pressure or cutting - disrupting the conveyance of necessary information and proper muscle function.

It is possible for nerve fibers to be negatively impacted by a stressful activity or injury, causing an interruption in its transmission of messages from the brain but leaving its insulating cover undamaged. When nerve fibers are cut but the insulation remains undamaged, the end farthest from the brain dies, which prompts a recovery process to begin at the end closest to the brain.

But, when both the nerve fiber and its insulation are cut, a recovery process does not begin automatically. In fact, a small mass may form at the end of the cut - forming a nerve scar, or neuroma. A neuroma can be painful and may even cause an electrical sensation when touched.

Risk Factors
Nerve injuries can affect anyone at any age, because they comprise a delicate network that runs throughout our body and can be disrupted by any number of activities or accidents. Though, a large number of nerve injuries commonly involve falls, collisions, motor vehicle accidents, fractures, gunshot wounds, cuts and other forms of penetrating trauma.

Diagnosis and Treatment
There are a number of ways to determine if nerve damage has occurred and to what extent it has been affected. Following a thorough review of the patient's medical history and incident causing the injury, there is a full assessment of the injury and affected area, as well as the location of pain during hand movement, the loss of strength in the muscle supplied by the suspected nerve, and the location of numbness and loss of hand, finger or thumb function. Other signs of "innervation" deficiencies may be evident in the skin. Dry, shiny skin that does not wrinkle when immersed in water is the result of skin denervation. Electrodiagnostic testing can determine the severity of damage and grade of injury.

The treatment option is determined based on the location of the damage and severity of the injury, as well as the type of daily activities and work to which patients must return. Conservative treatment may be all that is indicated and may consist of supportive therapy in order to maintain range of motion and muscle tone. A minimally invasive end-to-end suture closure, or surgical repair may be indicated.

Simple nerve injuries may be repaired immediately, while a more complex wound - possibly involving multiple injuries - may need to be postponed until other injuries are addressed and potential development of scar tissue assessed.

Ultimately, the end result and recovery depends on the age of the patient, the type of wound and nerve involved, as well as the location of the injury. Though, targeted physical therapy greatly improves the chances of resuming normal function.