Treating Nerve Damage in the Hand & Wrist
Treating nerve damage in the hand & wrist at a glance
- Treating nerve damage in the hand and wrist is an attempt to reverse a defect that prevents a nerve from transmitting the proper electrical signal.
- This can occur when the hand or wrist is injured by being cut, crushed, burned or overstretched, damaging the nerve or the end of the nerve.
- The treatment options are generally immobilization or surgery, depending on the type and extent of the nerve damage.
- Treating nerve damage can help alleviate the pain and other symptoms so the patient can return to full function of the hand/wrist.
Diagnosing nerve damage in the hand or wrist
The hand is the part of the body most likely to be affected by nerve damage. The method of treating nerve damage in the hand and wrist depends on the type and extent of the damage. This is determined by a diagnosing orthopedist.
The three categories of nerve damage are:
- Neurapraxia is a stunned or bruised nerve from a stretch or a blow, such as hitting one’s “funny bone.” This is mild damage and goes away within a few weeks.
- Axonotmesis is a stretching of the nerve’s electrical cable element with no harm to the outer insulating layer. This is more serious, and recovery may be only partial. This may take some time, with loss of some nerve function possible.
- Neurotmesis is the most severe, involving separation of the nerve ends. Surgery is often indicated for recovery.
Some nerve damage in the hand or wrist can involve aspects of all three types of injuries. The doctor may not be able to easily determine what type of damage has occurred, as pain and swelling make this difficult. Also complicating diagnosis is that patients often wait to seek treatment after an injury and do not suspect their symptoms are nerve damage.
The orthopedist will discuss the injury with the patient, including how it happened. He or she will examine the injury site and test the patient’s motor function in the muscles that are stimulated by the affected nerves. This will involve the patient moving certain parts of the arm or hand.
Most often the physical exam will result in a diagnosis of the type of injury to the hand or wrist nerve. Sometimes following a period of about six weeks after an injury, an electrical-impulse test may be used to gauge the nerve’s functional ability.
Treatment options for hand & wrist nerve damage
The general treatments are repairing the cause of the nerve damage in the hand or the wrist, therapy, immobilization and surgery. The less the damage, the greater the prospect that treatment will result in recovery.
Removing the cause of nerve damage depends on the type of injury. For example, a fracture can cause a bone fragment to push on a nerve, and a procedure to remove or reposition that fragment can bring relief. Sometimes an orthopedist can move a nerve away from the cause of damage. In these situations, the nerve may recover full function.
Immobilizing the hand and wrist
Immobilization is often used when trying to repair the damaged nerve. For instance, a nerve may be injured by being stretched and protecting it from further damage or more stretching is necessary for it to heal. That’s when immobilization is a form of treatment.
The physician may place the patient’s finger, hand or wrist in a brace or splint to stop the movement. Keeping the hand stationary prevents the nerve from becoming reinjured while it heals. Full recovery can take up to four weeks of immobilization to protect the nerve.
While resting the hand and wrist, medication that helps with inflammation such as ibuprofen may be used. Patients should clear any over-the-counter medications with their orthopedist to make sure they will not have any adverse reactions.
Surgical treatments for nerve damage
Surgery is primarily used when the nerve damage is extensive, as in neurotmesis when the nerve ends are severed. Surgery may also be required as part of the diagnosis to properly examine nerve damage and determine if repair is possible.
Orthopedic surgeons usually use three kinds of surgeries for hand or wrist nerve repair. Following surgery, elevation and immobilization of the affected area is often recommended.
- Nerve regeneration sews two ends of a nerve back together that have been cut or separated. The nerve endings regrow into the far end of the severed nerve, usually at a rate of about an inch per month.
- Nerve grafting uses a piece of nerve from elsewhere in the patient’s body (or from a donor) to connect the two nerve ends that are unable to touch on their own. This is frequently performed to correct crushed or burned nerves. Nerve grafting usually requires about four weeks of immobilization.
- Nerve transfers use fully functioning nerves in an area of the surgery and transfers them to the injured nerve. Nerve transfer is used when nerve grafting is not an option as a repair.
Reconstructive surgery may be tried about 6-12 months following attempted nerve repair when that has been shown not to work. This is a complex surgery that can involve rerouting a tendon from one working muscle to a nonworking one.
Risks of nerve damage treatments
Risks from immobilization treatments are minimal. Risk of surgery to treat nerve damage in the hand or wrist can involve loss of nerve function. Other risks are similar to those of all surgeries, including pain, tissue damage, bleeding, scarring, blood clotting, infection and reaction to anesthesia.
People experiencing pain in the hand or wrist associated with nerve damage should contact us to schedule an appointment and learn more about their treatment options.