Peripheral Nerve Injuries: when the hand loses sensation or movement

In the hand, three nerves are responsible for the vast majority of sensation and movement: the median nerve, the ulnar nerve, and the radial nerve. Each one follows its own path from the arm to the fingers, and each has a specific function: part of the sensation of the palm and fingers, motor control of muscles that allow pinching and gripping, and extension of the wrist and fingers, for example. An injury to any of these nerves can mean loss of sensation, loss of strength, or difficulty performing fine movements, such as buttoning a shirt or holding a small object.

Peripheral nerve injuries can manifest in different ways, depending on the timing and cause. Acute injuries result from recent trauma, such as a cut, a stretch, or a fracture that compresses the nerve at the time of the accident. Chronic injuries, on the other hand, develop progressively, often associated with compressions that evolve over time or with initial injuries that were not properly treated during the acute phase. This distinction is important because it directly influences which treatment strategy will be most effective.

When a nerve is severed, one of the first technical decisions is the timing of the repair. Primary repair is performed soon after the injury, generally still within the so-called "ideal window" for intervention, which tends to favor better nerve regeneration outcomes. Delayed repair, on the other hand, occurs when the diagnosis or intervention takes place at a later stage, whether due to delayed diagnosis, associated injuries that needed to be treated first, or other clinical factors. The type of repair chosen depends directly on the time elapsed since the injury and the condition of the nerve and surrounding tissues, since nerves that have been injured for longer periods may present retraction of the ends and changes that make direct reconstruction more difficult.

In cases where it is not possible to directly join the two ends of the injured nerve, either due to loss of a nerve segment or excessive retraction of the ends, nerve grafts are used. This technique consists of filling the existing gap with a segment of nerve, serving as a kind of bridge that guides the regeneration of nerve fibers from one end to the other.

When the complexity of the injury requires an even greater level of precision, microsurgical nerve reconstructions come into play. These techniques use magnification (such as surgical microscopes) and specialized instruments to reconnect microscopic structures, such as the fascicles that make up the nerve, with the greatest precision possible. This level of detail is essential in nerves that combine multiple sensory and motor functions, such as the median, ulnar, and radial nerves.

Another strategy used in the treatment of peripheral nerve injuries is nerve transfers. In this procedure, a healthy nerve, or part of it, is surgically redirected to assume the function of an injured nerve, especially in cases where direct reconstruction is not feasible, either due to the extent of the injury or the amount of time that has passed since the trauma. This technique is particularly relevant when the goal is to quickly restore some motor function before irreversible muscle atrophy occurs.

The management of peripheral nerve injuries requires specialized evaluation and, often, complex technical decisions about which approach offers the best chance of recovering sensation and motor function in the hand. Each of these techniques (primary repair, delayed repair, grafts, microsurgical reconstructions, and nerve transfers) has specific indications, which vary according to the nerve involved, the time since the injury, and the extent of the damage. The right choice, made by an experienced hand surgeon, can make all the difference in the patient's functional outcome.

If you experience any of these symptoms, or know someone who needs a specialized evaluation, visit riohandexperts.com.br/appointment and schedule an appointment. Our offices are located in different neighborhoods throughout Rio de Janeiro.

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Rio Hands Experts

Berlink & Eiras Premier Care

Rio de Janeiro - Brasil