Hand Tendon and Nerve Injuries Info
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Hand tendon and nerve injuries – understanding symptoms, diagnosis, and treatment options.
What you're feeling
You might feel pain or numbness in your hand or wrist. This often happens after an injury where a nerve or tendon is damaged. If you have a ballistic injury, the chance of these problems is higher if you also have a fracture. You may notice that your hand feels weak or that you cannot move certain fingers as you used to. Some people feel a painful lump called a neuroma, which can be very uncomfortable.
Daily tasks can become difficult when your hand does not work as it should. You might struggle to reach behind your back to fasten a bra or tuck in your shirt. Simple actions like lifting a cup or gripping a tool may feel hard or impossible. If you have a nerve injury, you might lose the ability to feel things touching your skin. In some cases, only 24% of repaired nerves regain feeling close to what you had before the injury.
Your symptoms may change depending on the time of day or your activity. Pain can flare up after you use your hand or when you try to sleep on the side. If you have a pediatric trigger thumb, your child might have trouble straightening their finger. While some treatments work well for children, the best age for surgery is not always clear. You may need to see an upper extremity specialist early to get the best results and avoid long-term disability.
What's actually happening
Your hand relies on a delicate balance between nerves and tendons. Nerves act like electrical wires sending signals, while tendons are strong ropes that pull your bones to create movement. When these are injured, the signals get lost or the ropes snap. This is why you might lose the ability to grip objects, especially those with smaller sizes, or feel a significant drop in speed when making a fist. Even if your wrist and fingers cannot move as far or as strongly as before, your hand can still function well.
In cases where nerves are damaged, your surgeon may choose to reconnect the wires or reroute a different nerve to take over the job. If the nerve cannot heal on its own, they might use a tendon transfer. This is like borrowing a rope from a less critical area to fix a broken one in a vital spot. For thumb injuries, rerouting a specific tendon can restore the ability to lift and move the thumb away from your palm. While the strength of the thumb and index finger might remain about 20% lower than your other hand, your overall ability to use your hand can still be very good.
Sensation is often the most important goal for repairs, making up 40% of the success, while length and appearance account for the rest. Sometimes, the pulley system that guides these tendon ropes has four parts instead of the traditional three. If you have conditions like wear-and-tear arthritis or inflammation, your surgeon might use a dynamic tenodesis to correct drifting fingers. The goal is always to limit stiffness while preserving the mobility and function you need for daily life.
What we can do about it
For many hand injuries, your surgeon may suggest a trial of non-surgical care first. If you have posterior interosseous nerve palsy without a space-occupying lesion, a six-week observation period is advisable to see if muscle recovery happens on its own. During this time, physiotherapy aims to maintain motion and prevent stiffness while you wait for signs of improvement. If you have no sign of muscle recovery after six weeks or if weakness gets worse, your surgeon will likely recommend exploring the nerve. For pediatric trigger thumb, surgery is effective in restoring motion with minimal risks, though the best age for this procedure is not yet clear.
Medical management focuses on controlling pain and supporting healing while you recover. If you have a high radial nerve injury, early intervention is key to better outcomes. Your surgeon may discuss nerve reconstruction if the gap is less than five centimeters or if the delay in repair is under six months. In some cases, grafting with three or more donor nerve cables helps restore function for gaps up to ten millimeters. While specific medication details are tailored to you, pharmacological therapy may be necessary alongside surgery for long-term recovery. For nerve gaps measuring less than two centimeters, collagen conduits can reliably restore function without needing a tissue graft.
Surgery is considered when conservative care reaches its limit or when the injury is too severe to heal on its own. Your surgeon may recommend tendon transfer if nerve repair does not result in useful function or is not possible. This procedure is often the choice of care for radial nerve palsy, especially when early return to work and social life is important. For high radial nerve injuries with defects of nine centimeters or greater, nerve reconstruction is attempted within eight months before moving to tendon transfers. If you have a closed partial flexor tendon rupture, surgical exploration allows your surgeon to remove the damaged segment to restore normal movement.
When to see someone
See your GP if you have persistent pain that does not improve with rest, or if you notice weakness or instability in your hand. Ask for a specialist review if your fingers lock, give way, or if symptoms interfere with your sleep or work. You need prompt care if you experience a sudden worsening of symptoms. This is especially important if you have a fracture, as this increases the risk of long-term disability from nerve and tendon injuries. Early presentation allows for better recovery, with primary repair possible up to two weeks after injury for some nerves. Delaying care beyond six months can reduce the chance of regaining sensation, as only 24% of repaired nerves recover close to pre-injury levels.
