In the intricate landscape of our hands, nerves play a pivotal role in providing sensation and guiding our every movement. The median, radial, and ulnar nerves are vital components of the arm, ensuring that our hands function seamlessly. When these nerves face injuries or paralysis, it can lead to significant challenges and discomfort.
There are three main nerves in the arm: the median, the ulnar, and the radial.
Median nerve is one of the major nerves of forearm and hand. It originates from the brachial plexus in the arm pit.
The median nerve provides-
Paralysis or palsy of the median nerve is usually seen in
Muscles of the hand (base of the thumb) atrophy and will –
There will be a complete loss of sensation over the thumb, index, middle, and half of the ring finger.
If the median nerve is damaged or cut, then surgical excision of the damaged part and nerve repair or grafting should be done as early as possible or within 1 year of the injury for best results.
In patients who present late or in cases where the nerve is damaged beyond repair, then tendon transfers should be done to strengthen the weak portions of the hand along with the nerve repair and grafting (only if feasible).
A strong functioning tendon of the hand is re-routed to substitute a weaker or lost movement of the hand.
During tendon transfers for median nerve palsy, one functioning tendon from the front of the hand is taken, re-routed, and sutured to the tendon of the outer aspect of the thumb so that the patient can abduct (bring out thumb) and also make a meaningful pinch with the other fingers. This would enable him or her to hold objects with the thumb and fingers (OPPONENSPLASTY).
The surgery is usually done under brachial block or general anesthesia and a splint or slab is given for immobilization in the post-operative period.
The radial nerve is one of three nerves in your forearm, traveling from the side of your neck, down the back of your arm, through your forearm and into your hand.
Your radial nerve is responsible for a lot of different arm movements, including-
It also supplies sensation to half of the back of the hand on the side of the thumb.
What causes radial nerve paralysis?
Paralysis or palsy of the radial nerve is usually seen in
There will be a complete loss of sensation over the thumb, index, middle, and half of the ring finger.
Such conditions of wrist drop and finger, thumb drop (inability to extend the wrist, thumb, and fingers) are usually seen in injuries of the radial nerve after accidents or fractures of the humerus (bone of the arm) or in long-standing compression of the radial nerves due to tumors or other reasons.
If the radial nerve is damaged or cut, then surgical excision of the damaged part and nerve repair or grafting should be done as early as possible or within 1 year of the injury for best results.
If the patient has presented with sudden onset of paralysis of the radial nerve, then other neurological causes or any nerve tumor should be investigated for.
If the patient presents with gradual paralysis of the radial nerve, then radial nerve compression – radial tunnel syndrome, Posterior interosseus nerve syndrome should be thought of and managed accordingly.
If the patient has presented late beyond the timing suitable for nerve repair (after 1.5 years of accident), or in cases where the nerve is damaged beyond repair, then tendon transfers should be done to strengthen the weak portions of the hand. A strong tendon of the hand is re-routed to substitute a weaker or lost movement of the hand.
During tendon transfers for radial nerve palsy, 3 functioning tendons from the front of the forearm and hand are taken, re-routed, and sutured to the tendons of the back of the forearm and hand so that the patient can extend his wrist, fingers, and thumb.
The ulnar nerve goes from neck down to your arm, forearm and to your hand.
Paralysis or palsy of the ulnar nerve is usually seen in
If the ulnar nerve is damaged or cut, then surgical excision of the damaged part and nerve repair or grafting should be done as early as possible or within 1 year of the injury for best results.
If the patient has presented late or the ulnar nerve is damaged beyond repair, then tendon transfers should be done to strengthen the weak portions of the hand along with nerve repair and grafting (only if feasible). A strong tendon of the hand is re-routed to substitute a weaker or lost movement of the hand.
During tendon transfers for ulnar nerve palsy, 2 functioning tendons from the front of the forearm and hand are taken, re-routed, and sutured to the tendons of the side of the fingers so that the patient can extend his or her fingers at their finger joints. This tendon transfer also enables a meaningful side pinch of the thumb.
The surgery is usually done under brachial block or general anesthesia and a splint or slab is given for immobilization in the post-operative period.
Digital nerves are nerves of the fingers that travel from the palm to the tips of the fingers and thumb. Each finger and thumb have 2 digital nerves running on the sides of the finger. They are responsible to provide sensation of pain, touch, temperature and pressure of their respective sides of the finger.
They can be commonly damaged by accidental injuries and less commonly by pressure or stretching. Injury to digital nerve stops the transmission of signals to and from the brain resulting in loss of sensation in the fingers.
Digital nerve injuries can be partial or complete. Repair is routinely recommended for complete injuries (completely cut nerve fibers). Injuries that only bruise the nerve or are partial, typically heal on their own in a few weeks.
Nerve repair after digital nerve injuries is important. If repair is not done, the sensory loss can leave the finger more prone to injuries and burns.
Since the sensory receptor does not degenerate, therefore, sensory nerve repair can be done anytime or years after the injury.
Digital nerve repair is a microsurgical procedure to reconnect the severed ends of a digital nerve in the finger or hand under the microscope. In a few cases where end-to-end repair is not possible, a suitable nerve graft is harvested from the back of the wrist or from the leg and the nerve is repaired with nerve grafting.
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The hand is served by three main nerves: the median, radial, and ulnar nerves. The median nerve provides sensation to the thumb, index, and middle fingers, along with thumb movement. The radial nerve controls forearm and wrist movements. The ulnar nerve offers sensation to the small and ring fingers and controls fine hand movements.
Paralysis or palsy of these nerves can result from injuries, conditions like leprosy, or prolonged compression of the nerve in certain locations.
Symptoms vary depending on the affected nerve but can include muscle atrophy, loss of sensation, and compromised hand movements. For specific symptoms, refer to each nerve’s section.
Diagnosis often involves a clinical examination and specific tests such as Nerve Conduction Velocities (NCV) and Electro-Myographic Studies (EMG).
Surgical interventions are usually recommended if there’s significant nerve damage or if the nerve has been cut. Surgery should ideally be performed within a year of the injury for the best results.
Yes, certain neurological conditions and diseases, like leprosy, may lead to nerve injuries. Late-stage nerve damage may result from other causes, including nerve compression syndromes.
In such cases, tendon transfers can be considered. Tendon transfers strengthen weakened hand functions, often replacing lost or compromised nerve functions.
Repairing cut or injured digital nerves is crucial to restore sensation and prevent the finger from becoming more susceptible to injuries and burns.
Recovery typically involves wearing a splint, experiencing pins and needles as the nerve heals, and gradually regaining sensation over several months.
Yes, partial digital nerve injuries often heal on their own within a few weeks. However, complete injuries usually require surgical intervention to regain sensation and functionality.
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