Nerve and Tendon Injuries

Nerve and tendon injuries most commonly result from lacerations of the hand. But can also be irritated from excessive and repetitive hand/finger movements, i.e. cell phone texting, excessive video gaming, or other job related repetitive motions.Nerve and Tendon Injuries This is called tendonitis or nerve compression and can heal with a period of cessation of the repetitive motion or minor surgery to correct the tendonitis. You can read about these in the trigger finger, wrist tendonitis, and carpal tunnel decompression sections on this web site.

Ruptured or lacerated nerve and tendon injuries are suspected following any deep laceration including innocent-looking stab wounds. The classic finding on examination is inability to fully flex or extend a finger/thumb. Adjacent structures, such as nerves or arteries, are frequently lacerated as well. A patient may report “bleeding that shot across the room”, clearly indicating a lacerated artery. When this occurs in a deep finger laceration, the injury to a digital artery is almost always accompanied by laceration of the adjacent digital nerve. A suspected sensory nerve laceration can be confirmed by careful sensory testing.

Tendon repair can be carried out within 2-3 weeks of the injury date. Improved suture materials and tendon-repair techniques have led to improved outcomes following tendon repair. Another major improvement has been the availability of Certified Hand Therapists and improved techniques for hand rehabilitation after tendon and nerve injuries. OrthoVirginia has 3 sites (Johnson-Willis, Chippenham, Henrico-Parham, and Hanover Regional) where CHTs are available for our patients.

Recovery from tendon repair involves several phases. Phase I is the protective phase, during which the injured tendon is protected by a postop bandage and subsequent light splint. The splint should be worn, as instructed by your CHT and surgeon; this may include the use of a sling. Phase II is the protected ROM phase in which your CHT will allow passive ROM (movement of an injured finger by the other hand) but no active ROM (movement of the finger by active muscle power). Phase III is the strengthening phase, which will be started once your CHT and surgeon advise it. Strengthening may take 3-5 months.

Nerve repair has also benefitted from modern microsurgical repair techniques. Surgical microscopes allow for accurate use of microscopic sutures (the size of human hair) or the use of collagen sleeves to repair nerves. But recovery from nerve repair requires even more time as nerve regeneration is a slow, gradual process taking 6-18 months. Again your CHT will coordinate the recovery phase, which requires extensive “re-education” of the hand as the repaired nerves begin to recover.