WHAT YOU SHOULD KNOW
There are many different nerves within the arm and hand that work together to provide feeling to touch, muscle movement, and numerous other functions including the ability to feel pain. Some nerves do all functions and are called mixed nerves. Other nerves do only a single function and are named after that function (ie: sensory nerve). Lacerations can occur anywhere along the arm to either mixed or single function nerves. After nerve injury function is lost and the nerve ends will separate. Only if the nerve is surgically repaired soon after injury will it be possible to avoid using nerve grafts to span a gap between the cut nerve ends.
MEDICAL HISTORY
Lacerated nerves often cause severe pain of a special type that patients quickly learn to recognize as coming specifically from damaged nerve tissue. Mostly patients will complain of the lost functions of feeling or muscle movement after nerve injury.
EXAMINATION
Specific tests to measure what capabilities have been lost and the amount of damage are performed function-by-function, one at a time.
ADDITIONAL TESTS
Electrical nerve tests will clearly demonstrate which nerves are functioning and which are not along with actual numbers to measure the severity of damage.
TREATMENT OPTIONS
| NON-OPERATIVE | SURGICAL NERVE REPAIR OR GRAFTING | SURGICAL TENDON TRANSFERS | |
| CONSISTS OF | Therapy and medications to control pain | Sewing together cut nerve ends or splicing nerve tissue between a gap in the ends | Rerouting a tendon to perform another function when it can afford to give up its original function |
| FEATURES | Medications are very sedating | Nerve graft harvest comes from the back of the leg | The brain must learn to use the tendon for its new function |
| ADVANTAGES | Avoids surgery | Regrowth of nerve to the original muscle intended for that function | Ready for use within a few months after tendon connections healed |
| DISADVANTAGES | Does nothing to recover nerve function | Extremely slow regrowth with only partial function expected to return | Transferred tendons must be retrained for a new function which is never quite the same as the original muscle group |
RECOVERY
After nerve reconstructive surgery by repair or graft the patient must wait a considerable amount of time, usually years to see the maximum amount of function that can be achieved. Normal function is almost never achieved except in children. After tendon transfer, splints are worn for around 6 weeks to protect the healing of new tendon connections. Once healed, therapy motion exercises and retraining of the brain to use the transferred tendons for their new functions takes several months. No matter which course is taken, this is a medical condition for which the final recovery is not achieved until at least many months later if not years.
