Sugat sa Tendones at Neryo ng Kamay Impormasyon

Ano ang nararamdaman mo

Maaaring mapansin mo ang sakit, pamamanhid, o pangangati sa iyong kamay o pulso. Karaniwang nangyayari ito pagkatapos ng isaksaks o kung mayroon kang kondisyon tulad ng osteoarthritis (wear-and-tear arthritis). Maaaring maramdaman mo ang sakit na matulis o mabigat. Maaari itong lumala sa gabi, na nagiging sanhi ng hirap sa pagtulog. Maaari ring maramdaman mo ang pagkakabigat o stiffness kapag gising ka pa lang sa umaga.

Maaaring maging mahirap ang mga gawain sa araw-araw. Ang mga simpleng kilos tulad ng pag-abot sa likod upang isara ang bra, pagtutukoy ng damit, o pag-angat ng tasa ng kape ay maaaring maramdaman na hindi komportable o nakakalason. Maaari kang madalas na mahulog ang mga bagay dahil sa mahina ang iyong hawak. Kung mayroon kang pinsala sa nerbiyos, maaaring maramdaman mo na hindi na gumagana ang iyong kamay tulad noong dati. Maaari itong gawing hindi matatag ang paghawak sa mga bagay.

Karaniwang lumalala ang sakit pagkatapos ng matagal na paggamit ng iyong kamay. Ang pagpapahinga nito ay karaniwang tumutulong upang bawasan ang sakit. Gayunpaman, kung hindi mo pansinin ang mga sintomas, maaaring tumagal ang hindi komportableng pakiramdam. Maaaring mapansin mong iwasan mo ang mga partikular na galaw upang protektahan ang iyong kamay. Maaari itong magdulot ng stiffness sa paglipas ng panahon.

Kung mayroon kang pinsala sa nerbiyos, maaaring mapansin mo ang mga pagbabago sa pakiramdam. May mga taong nagsasabi na ang kanilang mga daliri ay parang pamamanhid o parang natutulog. Sa ilang kaso, maaaring maramdaman mo ang pananakit na parang sunog o tumatagos. Karaniwang ito ay nauugnay sa pamamaga o peklat sa paligid ng nerbiyos. Kung mayroon kang pinsala sa tendon, maaaring marinig mo ang isang "pop" o maramdaman ang biglang "snap" kapag nangyari ang pinsala. Pagkatapos nito, maaaring mahirapan kang baluktot o tuwirin nang ganap ang iyong mga daliri.

Mahalagang bigyan ng pansin ang mga senyales na ito. Kung mayroon ka ng fracture, mas mataas ang risk ng pinsala sa nerbiyos at tendon. Maaari itong magdulot ng pangmatagalang kapansanan kung hindi ito tamang tratuhin. Karaniwan ang pinsala sa extensor tendon, at ang maagang pagkilala ay susi sa pamamahala nito. Ang pinsala sa flexor tendon ay mas bihira, lalo na sa mga bata, ngunit nangangailangan pa rin ito ng maingat na pagmamasid.

Kung ikaw ay karanasang nararamdaman ang mga sintomas na ito, ang mabilis na pag-refer sa isang espesyalista sa upper extremity ay makakatulong upang mapabuti ang iyong mga resulta. Gusto naming maunawaan kung ano ang nararamdaman mo upang maiplan ang pinakamainam na landas para sa iyong paggaling.

Ano ang nangyayari talaga

Ang iyong kamay ay umaasa sa isang kumplikadong sistema ng mga tendon, nerbiyos, at ligamento upang makagalaw at makaramdam. Ang mga tendon ay gumagana tulad ng matibay na lubid na nag-uugnay sa iyong mga kalamnan sa iyong mga buto. Hinahatak nito ang iyong mga daliri at hinlalaki upang lumikha ng galaw. Ang mga nerbiyos ay ang mga kable na nagdadala ng mga signal mula sa iyong utak patungo sa iyong kamay. Ipinapaalam nito sa iyong mga kalamnan kung kailan dapat kumilos at ipinapadala ang pakiramdam pabalik sa iyong utak. Ang mga ligamento ay matigas na banda na nag-i-iugnay sa iyong mga buto sa tamang posisyon.

Kapag nasugatan ang mga estrukturang ito, nababagsak ang sistema. Maaaring maghiwalay ang isang putol na tendon mula sa buto, na mag-iiwan sa iyo na hindi makabentura ng isang daliri. Ang isang nasirang nerbiyos ay maaaring huminto sa pagdating ng mga signal sa iyong mga kalamnan. Ito ay nagdudulot ng kahinaan o panghihina. Maaaring mapansin mo na mas mahina ang iyong hawak, lalo na kapag hawak ang mga maliit na bagay. Ang mga simpleng gawain tulad ng paggawa ng kamay na nakakunot ay maaaring maging mabagal o masakit. Ang makinis na patong sa iyong mga buto, na tinatawag na kartilago, ay maaaring magkasira. Ito ay nagdudulot ng alitan at katigasan sa kasukasuan.

Tinitingnan ng iyong doktor ang partikular na pinsala upang magplano ng iyong pagkukumpuni. Halimbawa, kung ang isang nerbiyos ay naunat o naputol, maaari naming subukang ikonekta ito nang direkta. Kung ang nerbiyos ay sobrang nasira, maaari naming gamitin ang tendon transfer. Ito ay nangangahulugang paglipat ng isang gumagana na tendon upang kumuha ng trabaho ng nasugatan. Maaari nitong ibalik ang function kapag hindi posible ang direktang pagkukumpuni ng nerbiyos. Sa ilang kaso, pinagsasama namin ang pagkukumpuni ng nerbiyos sa tendon transfer upang mapabuti ang kakayahan ng iyong kamay na hawakan at palayasin ang mga bagay.

Ang pakiramdam ay isang mahahalagang bahagi ng paggaling. Ito ay bumubuo ng 40% ng layunin sa mga pagkukumpuni ng hinlalaki o dulo ng daliri. Ang haba at itsura ay bumubuo ng 50%. Layunin naming ibalik hindi lamang ang galaw, kundi pati na rin ang pakiramdam na tumutulong sa iyo na gamitin ang iyong kamay nang ligtas. Pipiliin ng iyong doktor ang pinakamainam na paraan batay sa kung saan ang sugat at kung gaano kahirap ito. Ang layunin ay ibalik ka sa paggamit ng iyong kamay para sa pang-araw-araw na buhay.

Mga maitutulong namin dito

Ang inyong pinagdaanan para sa sugat sa tendon o nerbiyo ng kamay ay nakadepende sa kung gaano katagal ang pinsala at kung paano ito nakakaapekto sa inyong pang-araw-araw na buhay. Si Dr Kieran Hirpara, isang surgyeon sa itaas na bahagi ng katawan sa Mater Private Hospital Rockhampton, ay nagtataguyod ng ating pag-aalaga sa pamamagitan ng pagpapanumbalik ng inyong kakayahan nang ligtas. Dumating ang mga pasyente sa aming klinika sa pamamagitan ng referral mula sa GP o physiotherapist. Isang pagsusuri sa klinika, kabilang ang kasaysayan, pagsusuri, at pag-imaging kung kinakailangan, ang nagtatatag ng diagnosis. Para sa mga dehenratibo o matagal nang problema, karaniwang sinusubukan muna namin ang non-operative na paggamot. Kasama rito ang pagbabago ng aktibidad, physiotherapy o hand therapy, paggamit ng splint, at mga injeksyon. Isinasalang-ala namin ang operasyon kapag hindi ito nagbigay ng sapat na pagpapabuti. Para sa mga structural o acute na problema, maaaring irekomenda agad ang operasyon, nang walang naunang subok sa non-operative na paggamot.

Sa mga maagang yugto, gabay ng inyong physiotherapist ang inyong pagpasa sa banayad na mga galaw upang panatilihin ang flexibility ng mga kasu-kasuan at maiwasan ang stiffness. Ang layunin ay panatilihin ang lakas ng mga nakapaligid na kalamnan habang ang mga sugatang tissue ay gumagaling. Kung mayroon kayong sakit, maaaring imungkahi ng inyong surgyeon ang over-the-counter na gamot sa sakit o anti-inflammatories upang matulungan kayong pamahalaan ang hindi komportableng pakiramdam. Para sa ilang kondisyon, tulad ng trigger thumb sa mga bata o tiyak na mga isyu sa tendon, maaaring pag-usapan namin ang mga injeksyon. Maaaring bawasan ng mga injeksyon ng cortisone ang inflammation at sakit, madalas na nagbibigay ng ginhawa sa loob ng ilang linggo hanggang buwan. Ang mga injeksyon ng hyaluronic acid o platelet-rich plasma (PRP) ay minsan ginagamit upang suportahan ang kalusugan ng tissue, bagama't nag-iiba ang tagal ng benepisyo. Inaangkop namin ang mga opsyon na ito sa partikular na sugat at antas ng sakit ng bawat isa.

Isinasalang-ala ang operasyon kapag ang conservative na paggamot ay umabot na sa hangganan o kapag kinakailangan ang agad na pag-aayos para sa kaligtasan. Para sa mga laceration ng tendon, maaaring gawin ang primary repair kung darating ka agad na may malinis na sugat; kung hindi, maaaring kailanganin ang tendon graft. Mga komplikadong isyu ang mga sugat sa nerbiyo. Kung putulin ang nerbiyo, maaaring subukan namin ang direktang repair o gumamit ng nerve graft upang punan ang mga puwang. Para sa mga puwang na mas mababa sa 2 cm, maaaring muling ibalik ng mga collagen conduit ang kakayahan. Kung hindi posible ang pag-aayos ng nerbiyo o hindi ito nagresulta sa kapaki-pakinabang na kakayahan, maaaring irekomenda namin ang tendon transfer. Ang prosedurang ito ay gumagamit ng gumagana nang tendon upang kumuha ng trabaho ng nasirang isa. Para sa radial nerve palsy, nag-aalok ang mga tendon transfer ng mahalagang alternatibo sa nerve reconstruction, lalo na kapag mahalaga ang maagang pagbabalik sa trabaho. Sa mga kaso ng tetraplegia, ginagamit ang kombinasyon ng nerve at tendon transfers upang muling ibalik ang paghawak at paglaya. Pinag-uusapan namin ang mga opsyon na ito sa iyo, tinitiyak na nauunawaan mo ang mga potensyal na benepisyo at panganib bago magpatuloy.

Ano ang inaasahan

Ang iyong paggaling ay nakadepende sa tiyak na sugat at sa piniling gamutan. Kung mayroon kang sugat sa nerbiyos, maaaring mabagal at hindi kumpleto ang paggaling ng pandama. 24% lamang ng mga nag-aayos na indibidwal na nerbiyos sa mga daliri ng mga matatanda ang nakakabalik sa pandama na malapit o katumbas ng tinantyang antas bago ang sugat. Ibig sabihin, karamihan sa mga tao ay magkakaroon ng ilang pangmatagalang pagbabago sa pandama. Gayunpaman, kung mayroon kang replantasyon ng dulo ng daliri nang walang pag-aayos ng nerbiyos, sapat na paggaling ng pandama ay maaari pa ring mangyari sa pagsubaybay sa dalawang taon.

Kapag ang pag-aayos ng nerbiyos lamang ay hindi naibalik ang kapaki-pakinabang na pagganap, maaaring irekomenda ng iyong doktor ang paglipat ng inat. Ang prosedurang ito ay gumagamit ng gumagana na inat upang palitan ang nasirang inat. Ito ay isang kapaki-pakinabang na opsyon para sa mga sugat sa radial, median, o ulnar na nerbiyos. Maaari itong maging piniling pagpipilian kung ang maagang pagbabalik sa trabaho at buhay panlipunan ay mahalaga sa iyo. May ilang ebidensya na nagmumungkahi na ang mga paglipat ng inat ay nag-aalok ng mas mataas na mga rate ng mas mahusay na mga klinikal na resulta kumpara sa mga paglipat ng nerbiyos para sa natatanging paralisis ng radial na nerbiyos.

Maaari ka ring magkaroon ng pag-aayos ng nerbiyos at paglipat ng inat nang sabay. Ang pinagsamang pamamaraang ito ay nagpapakita ng walang masamang resulta at maaaring magbigay ng pinabuting pagganap kaysa sa paglipat ng inat lamang. Para sa mataas na mga sugat sa radial na nerbiyos na may mga defekto na 9 cm o higit pa, tila indikado ang pagtatangkang muling pagbuo ng nerbiyos bago lumipat sa mga paglipat ng inat sa loob ng 8 buwan. Kung ikaw ay magpapakita nang maaga at kayang tanggapin ang mas mahabang oras para sa paggaling ng pagganap, maaari kang maging optimal na kandidato para sa mga paglipat ng nerbiyos kaysa sa mga paglipat ng inat.

Ang rehabilitasyon ay isang mahahalagang bahagi ng iyong pananaw. Ang maagang rehabilitasyon pagkatapos ng pag-aayos ng inat sa kamay ay kapaki-pakinabang. Isang rehabilitatibong protokol na indibidwal na angkop sa iyong tiyak na patolohiya ng inat at operasyon ay mahalaga. Karamihan sa mga hindi magandang resulta pagkatapos ng mga prosedura tulad ng bukas na pagpapalaya ng A1 pulley ay pansamantalang sakit, stiffness, at pamamaga. Ang mga pangunahing komplikasyon tulad ng sugat sa nerbiyos o malalim na impeksyon ay bihira.

Kung iiwan lamang, ang mga sugat sa nerbiyos at inat na may kaugnayan sa mga fracture ay may mas mataas na panganib ng pangmatagalang kapansanan. Maaaring pamahalaan nang maayos, maraming pasyente ang nakakabalik ng malaking pagganap. Ang paglipat ng inat ay nag-aalok ng isang mahalagang alternatibo sa microsurgical na muling pagbuo ng nerbiyos. Tumutulong ito na muling pag-andar kapag ang pagsasanay sa nerbiyos ay hindi posible o hindi nagresulta sa kapaki-pakinabang na pagganap. Ang iyong doktor ay talakayin kung aling landas ang nag-aalok ng pinakamataas na pagkakataon para sa iyong tiyak na pangangailangan.

Kailan kumonsulta sa doktor

Humingi ng pagsusuri ng espesyalista kung mayroon kang patuloy na sakit na hindi gumagaling kahit pahinga, o biglaang kahinaan at kawalan ng katatagan sa iyong kamay. Humingi ng agad na pag-aalaga kung ang iyong mga daliri ay nakakabit o biglang nawawalan ng lakas, o kung ang mga sintomas ay nakakaapekto sa iyong tulog o trabaho. Ang mga fracture ay may kaugnayan sa mas mataas na panganib ng pinsala sa nerbiyos at tendon, na maaaring magresulta sa pangmatagalang kapansanan. Ang maagang pagkilala sa mga pinsala ng extensor tendon ay susi sa pamamahala. Kung mayroon kang mataas na pinsala sa radial nerve na may defect na 9 cm o higit pa, ang pagtatangka ng rekonstruksyon ng nerbiyos bago magpatuloy sa mga tendon transfer ay tila indikado sa loob ng 8 buwan. Ang mabilis na referral ay tumutulong upang mapabuti ang mga resulta.

Evidence & references

This is the clinical evidence summary written for health professionals. It is technical, and it lists the research this page was built from. You do not need to read it to understand your treatment or to make a decision about it.

Overview

Early neurorrhaphy of acute nerve injuries provides the best outcome [1].
Distal motor nerve transfers should be considered to preserve hand intrinsic motor function when nerve injuries occur at or above the proximal forearm [1].
Nerve transfer is favored over nerve grafting in managing high ulnar nerve injuries because of better improvement of motor power and better restoration of grip functions of the hand [5].
In lower-type injuries of the brachial plexus, transfer of median nerve branches that innervate the palm of the hand to the ulnar proper digital nerve of the little finger predictably restored protective sensation on the ulnar side of the hand [6].
End-to-side distal anterior interosseous nerve transfer provides significantly better results than a standard more proximal nerve repair in the treatment of proximal ulnar nerve injuries [12].
Vascularized ulnar nerve grafts should be recommended for reconstruction of the median or radial nerves in selected cases involving large defects after severe trauma of the upper extremity [14].
High median nerve injuries result in absent thumb and index finger flexion and pulp anesthesia, which do not benefit from nerve grafting but are amenable to nerve transfers [25].
Tendon transfers remain the primary reconstructive procedure for paralytic injuries of the upper limb until sufficiently powered studies of nerve transfer outcomes are published [36].
Experimental studies and positive reports from large clinical series suggest that new techniques using foreign nerves for reinnervation are worthy of integration into the management of upper brachial plexus injuries, though many questions regarding timing, donor morbidity, and comparative efficacy remain unanswered [11].
Clinically, nerve transfer to the median nerve using parts of the ulnar and radial nerves may offer an alternative option for proximal nerve injuries or for free functioning muscle transplantations [16].
The biomechanical principles, indications and limitations of tendon transfers, nerve transfers and combined approaches are compared, with particular attention to timing, patient selection, and functional goals [3].

Anatomy & Pathophysiology

High median nerve transection results in a specific clinical presentation of hand function [2].
Biomechanical principles, indications, and limitations of tendon transfers, nerve transfers, and combined approaches depend on timing, patient selection, and functional goals [3].
Ballistic injuries to the hand are frequently associated with fractures and neurovascular and tendon injuries [4].
Upper extremity peripheral nerve injuries involve the median, radial, and ulnar nerves [8].
A nerve transfer for restoration of ulnar finger flexion through the pronator teres motor branch can be suggested in cases where the hand is partially involved to allow patients to regain or strengthen finger flexion [9].
Functional prehension requires a stable wrist and at least two sensate digits that can oppose with some power [10].
Severe hand injuries from sword assaults can cause devastating loss of function [15].
In combined proximal median and ulnar nerve injuries, restoring ulnar intrinsic function is critical to avoid blunt traditional anticlaw procedures, even if it requires some sacrifice of thumb motors [23].
Opposition transfers do not require large amounts of strength to achieve thumb positioning; the mechanics and vector of pull are of paramount importance [28].
An ulnar nerve to musculocutaneous nerve transfer in an ulnar ray-deficient infant with brachial plexus birth palsy resulted in active elbow flexion to 90° at 18 months without motor deficits in the hand [30].
Opposition is a preparatory position for grasp involving abduction, flexion, and pronation, primarily driven by the thenar intrinsic muscles [31].
A distally based extensor digiti minimi tendon transfer maximizes adducting force and overcomes reciprocal inhibition to correct a persistently abducted little finger [32].
There is no significant difference in hand function between border and central finger digital nerve injuries, except for lower grip strength in central finger injuries [33].
Outcomes for pediatric mutilating hand injuries tend to be better than in adults regarding mobility, sensory return, and appearance [37].
The quadriga phenomenon is caused by interconnected flexor digitorum profundus tendons and significantly affects clinical situations including strength testing, movement assessment, and rehabilitation exercise selection [39].

Classification

High median nerve transection presents with preserved finger flexion [2].
Tendon transfers, nerve transfers, and combined approaches are distinguished by their biomechanical principles, indications, limitations, timing, patient selection, and functional goals [3].
Nerve transfer is favored over nerve grafting in managing high ulnar nerve injuries due to better improvement of motor power and better restoration of grip functions [5].
Transfer of median nerve branches that innervate the palm of the hand to the ulnar proper digital nerve of the little finger predictably restores protective sensation on the ulnar side of the hand in lower-type brachial plexus injuries [6].
Transfer of the superficial radial or dorsal cutaneous branch of the ulnar nerve, or both, produces successful restoration of innervation of the thumb, index, and long fingers in experimental sensory reinnervation models [7].
Upper extremity peripheral nerve injuries include median, radial, and ulnar nerve injuries [8].
Nerve transfer for restoration of ulnar finger flexion through the pronator teres motor branch can be suggested in cases where the hand is partially involved to allow patients to regain or strengthen finger flexion [9].
Vascularized ulnar nerve grafts should be recommended for reconstruction of median or radial nerves in selected cases with large defects after severe upper extremity trauma [14].
Diagnosis-specific model instruments for outcome after nerve repair at the wrist or distal forearm level include new test instruments for assessment of tactile gnosis [21].
Supercharged end-to-side anterior interosseous nerve transfer (SETS) exhibits a remarkable role in treating high ulnar nerve damage by supplying intrinsic muscles and allowing for proximal nerve regeneration [27].
A reliable tendon prosthesis inserted as one stage in tendon reconstruction is an additional step needed to improve results of flexor-tendon reconstructive surgery in hands with severe damage [40].

Clinical Presentation

High median nerve transection can present with preserved finger flexion [2].
Transfer of the superficial radial or dorsal cutaneous branch of the ulnar nerve, or both, produced successful restoration of innervation of the thumb and index and long fingers [7].
Upper extremity peripheral nerve injuries present to emergency departments [8].
Nerve transfer for restoration of ulnar fingers flexion through the pronator teres motor branch can be suggested in cases where the hand is partially involved to allow patients to regain or strengthen finger flexion [9].
End-to-side distal anterior interosseous nerve transfer in treatment of proximal ulnar nerve injuries provides significantly better results than a standard more proximal nerve repair [12].
The triad of multiple metacarpal fractures and/or dislocations of the fingers, severe hand swelling, and clinical evidence of acute median nerve dysfunction can occur [13].
Severe hand injuries resulting from sword assaults can cause devastating loss of function [15].
The choice of surgical technique and timing for peripheral nerve injury depends on the type of trauma, site of injury, and time elapsed since injury [17].
Spontaneous recovery occurs in 70%–88% of radial nerve injuries [17].
Direct radial to ulnar nerve transfer via an interosseous tunnel safely and effectively restored intrinsic function before terminal muscle degeneration in a patient with combined proximal median and ulnar nerve injury [19].
The prognosis for recovery of peripheral neuropathies is good unless the nerve has been completely destroyed [22].
Traumatic neurapraxia in digital nerve injuries of the hand is not uncommon and has a favourable prognosis [29].

Investigations

Evaluation based only on a photograph taken in the emergency department was insufficient for the detection of neurovascular bundle injuries, tendon ruptures, and fractures [43].
The hand requires a stable wrist and at least two sensate digits that can oppose with some power for functional prehension [10].

Treatment

Transfer of the superficial radial or dorsal cutaneous branch of the ulnar nerve, or both, produced successful restoration of innervation of the thumb and index and long fingers in experimental sensory reinnervation models [7].
Nerve transfer using the pronator teres motor branch can be suggested in cases where the hand is partially involved to allow patients to regain or strengthen finger flexion [9].
Experimental studies and positive reports from large clinical series suggest that new techniques using foreign nerves for reinnervation are worthy of integration into the management of upper brachial plexus injuries [11].
Clinically, nerve transfer using parts of the ulnar and radial nerves may offer an alternative option for proximal nerve injuries or for free functioning muscle transplantations [16].
Distal nerve transfers for the treatment of high ulnar nerve injuries allow for a shorter reinnervation period and improved ulnar intrinsic recovery, which is critical to function of the hand [18].
The thenar branch of the median nerve may support ulnar nerve regeneration and help prevent intrinsic muscles from irreversible atrophy, though the procedure requires validation by future clinical data [20].
In devastating combined proximal median and ulnar nerve injuries, some sacrifice of thumb motors may be necessary to restore ulnar intrinsic function and avoid blunt traditional anticlaw procedures [23].
Early nonsurgical management for up to 6 months in adults and 9 months in children has expanded from closed humeral shaft fractures to include operative fractures that do not require nerve exposure, secondary palsies, and distal third humerus fractures [26].
Supercharged end-to-side anterior interosseous nerve transfer (SETS) exhibits a remarkable role in the treatment of high ulnar nerve damage by supplying intrinsic muscles and allowing for proximal nerve regeneration [27].
The thenar motor branch (OP branch) consistently reached the deep terminal motor branch of the ulnar nerve without tension, supporting its use to restore pinch after ulnar nerve injuries [35].
When nonoperative treatment fails, tendon transfers may be used for ulnar nerve injuries, with preferred options including ECRB to AP, APL to first DI, and splint FPL to EPL transfers evaluated on an individual basis [41].

Complications

Full recovery of median nerve function was seen in all patients with the triad of multiple metacarpal fractures/dislocations, severe hand swelling, and acute median nerve dysfunction at a mean final follow-up of 7 months [13].
All patients with the triad of multiple metacarpal fractures/dislocations, severe hand swelling, and acute median nerve dysfunction were able to return to work [13].
High ulnar nerve injuries can result in loss of ulnar intrinsic motor function [1].
High ulnar nerve injuries can lead to irreversible atrophy of intrinsic muscles [20].
Nerve transfers have revolutionized care for peripheral nerve injuries [24].

Recovery

Nerve transfer is favored over nerve grafting in managing high ulnar nerve injuries because of better improvement of motor power [5].
Nerve transfer is favored over nerve grafting in managing high ulnar nerve injuries because of better restoration of grip functions of the hand [5].
Transfer of the superficial radial or dorsal cutaneous branch of the ulnar nerve, or both, produced successful restoration of innervation of the thumb and index and long fingers in experimental sensory reinnervation studies [7].
The hand requires a stable wrist for functional prehension [10].
The hand requires at least two sensate digits that can oppose with some power for functional prehension [10].
New techniques using foreign nerves for reinnervation are worthy of integration into the management of upper brachial plexus injuries, though many questions regarding timing, donor morbidity, and comparative efficacy remain unanswered [11].
At a mean final follow-up of 7 months, full recovery of median nerve function was seen in all patients with the triad of multiple metacarpal fractures/dislocations, severe hand swelling, and acute median nerve dysfunction [13].
Nerve transfer to the median nerve using parts of the ulnar and radial nerves may offer an alternative option for proximal nerve injuries or for free functioning muscle transplantations [16].
The choice of surgical technique and timing for peripheral nerve injury of the upper extremity depends on the type of trauma, site of injury, and time elapsed since injury [17].
Distal nerve transfers for the treatment of high ulnar nerve injuries allow for a shorter reinnervation period [18].
Distal nerve transfers for the treatment of high ulnar nerve injuries allow for improved ulnar intrinsic recovery [18].
Improved ulnar intrinsic recovery is critical to function of the hand [18].
Additional long-term follow-up and case series are warranted for nerve transfers in peripheral nerve injuries [24].
Early nonsurgical management for up to 6 months in adults is indicated for radial nerve injuries associated with closed humeral shaft fractures [26].
Early nonsurgical management for up to 6 months in adults is indicated for radial nerve injuries associated with operative fractures that do not require nerve exposure [26].
Early nonsurgical management for up to 6 months in adults is indicated for radial nerve injuries associated with secondary palsies [26].
Early nonsurgical management for up to 6 months in adults is indicated for radial nerve injuries associated with distal third humerus fractures [26].
Early nonsurgical management for up to 9 months in children is indicated for radial nerve injuries associated with closed humeral shaft fractures [26].
Scarring from injury or previous surgery compromises results in flexor-tendon grafts in the fingers and thumb [44].
Joint stiffness compromises results in flexor-tendon grafts in the fingers and thumb [44].
Nerve damage compromises results in flexor-tendon grafts in the fingers and thumb [44].
The level of injury does not influence results in flexor-tendon grafts in the fingers and thumb [44].
Time to operation does not influence results in flexor-tendon grafts in the fingers and thumb [44].

Key Evidence

[L5] Early neurorrhaphy of acute nerve injuries provides the best outcome, but consideration should also be given to performing distal motor nerve transfers to preserve hand intrinsic motor function when injuries occur at or above the proximal forearm. [1] (10.1016/j.jhsa.2014.04.038)
[Case_report] This case contributes further to our understanding of the clinical presentation of hand function following high median nerve transection. [2] (10.1186/s12891-025-08469-3)
[L5] The biomechanical principles, indications and limitations of tendon transfers, nerve transfers and combined approaches are compared, with particular attention to timing, patient selection, and functional goals. [3] (10.1177/17531934261416300)
[L4] Ballistic injuries to the hand are frequently associated with fractures and neurovascular and tendon injuries. [4] (10.1177/15589447221092111)
[L4] Nerve transfer is favored over nerve grafting in managing high ulnar nerve injuries because of better improvement of motor power and better restoration of grip functions of the hand. [5] (10.1016/j.jhsa.2017.01.027)
[L4] In lower-type injuries of the brachial plexus, transfer of median nerve branches that innervate the palm of the hand to the ulnar proper digital nerve of the little finger predictably restored protective sensation on the ulnar side of the hand. [6] (10.1016/j.jhsa.2012.02.047)
[L5] Transfer of the superficial radial or dorsal cutaneous branch of the ulnar nerve, or both, produced successful restoration of innervation of the thumb and index and long fingers. [7] (10.2106/00004623-197759030-00016)
[L4] This study provides a critical overview of upper extremity peripheral nerve injuries. [8] (10.1016/j.jht.2026.02.012)
[L5] This specific procedure can be suggested in cases where the hand is partially involved to allow patients to regain or strengthen fingers flexion. [9] (10.1016/j.jhsg.2025.100844)
[L5] The hand requires a stable wrist and at least two sensate digits that can oppose with some power for functional prehension. [10] (10.1016/s0749-0712(02)00130-0)
[L5] Experimental studies and positive reports from large clinical series suggest that new techniques using foreign nerves for reinnervation are worthy of integration into the management of upper brachial plexus injuries, though many questions regarding timing, donor morbidity, and comparative efficacy remain unanswered. [11] (10.1054/jhsb.2000.0460)
[L4] It provides significantly better results than a standard more proximal nerve repair. [12] (10.1016/s0363-5023(11)60008-7)
[L4] At a mean final follow-up of 7 months, full recovery of median nerve function was seen in all patients, and all patients were able to return to work. [13] (10.1177/1753193408087105)
[L4] This technique should be recommended for reconstruction of the median or radial nerves in selected cases. [14] (10.1016/j.jhsa.2005.03.017)
[L4] This case series demonstrates the extent and severity of hand injuries that can be caused by sword assaults with devastating loss of function for the victims. [15] (10.1177/1753193410381576)
[L5] Clinically, this technique may offer an alternative option for proximal nerve injuries or for free functioning muscle transplantations. [16] (10.1054/jhsb.2000.0389)
[L4] The choice of surgical technique and timing depends on the type of trauma, site of injury, and time elapsed since injury, with spontaneous recovery occurring in 70%–88% of radial nerve injuries. [17] (10.1177/17531934241240867)
[L5] Distal nerve transfers for the treatment of high ulnar nerve injuries allow for a shorter reinnervation period and improved ulnar intrinsic recovery, which is critical to function of the hand. [18] (10.1016/j.hcl.2015.12.009)
[Case_report] Direct radial to ulnar nerve transfer via an interosseous tunnel safely and effectively restored intrinsic function before terminal muscle degeneration in a patient with combined proximal median and ulnar nerve injury. [19] (10.1016/j.jhsa.2014.04.013)
[L4] The thenar branch of the median nerve may support ulnar nerve regeneration and help prevent intrinsic muscles from irreversible atrophy, but the report is preliminary and the procedure should be validated by future clinical data. [20] (10.1177/1753193416675069)
[L5] The paper reviews the developmental process of a diagnosis-specific Model instrument for outcome after nerve repair at wrist or distal forearm level, including a new test instrument for assessment of tactile gnosis. [21] (10.1016/s0749-0712(03)00003-9)
[L3] The prognosis for recovery is good unless the nerve has been completely destroyed. [22] (10.2106/00004623-197658010-00011)
[Letter] The authors acknowledge the concerns regarding potential thumb function loss but emphasize the critical need to restore ulnar intrinsic function to avoid blunt traditional anticlaw procedures, suggesting that some sacrifice of thumb motors may be necessary in devastating combined proximal median and ulnar nerve injuries. [23] (10.1016/j.jhsa.2014.10.067)
[Letter] The original authors state that nerve transfers have revolutionized care for peripheral nerve injuries and that additional long-term follow-up and case series are warranted. [24] (10.1016/j.jhsa.2014.07.058)
[L4] High median nerve injuries result in absent thumb and index finger flexion and pulp anesthesia, which do not benefit from nerve grafting but are amenable to nerve transfers. [25] (10.1016/j.hcl.2015.12.008)
[L5] Early nonsurgical management for up to 6 months in adults and 9 months in children has expanded from closed humeral shaft fractures to include operative fractures that do not require nerve exposure, secondary palsies, and distal third humerus fractures. [26] (10.5435/jaaos-d-17-00325)
[L4] SETS exhibit a remarkable role in the treatment of high ulnar nerve damage by supplying intrinsic muscles and allowing for proximal nerve regeneration. [27] (10.1186/s12891-024-07650-4)
[L5] Opposition transfers do not require large amounts of strength to achieve the goal of thumb positioning; the mechanics and vector of pull are of paramount importance. [28] (10.1016/j.hcl.2016.03.005)
[L4] Traumatic neurapraxia in digital nerve injuries of the hand is not uncommon and has a favourable prognosis. [29] (10.1007/s00402-007-0299-6)
[Case_report] The procedure resulted in active elbow flexion to 90° at 18 months without motor deficits in the hand. [30] (10.1016/j.jhsa.2010.06.014)
[L5] Opposition is a preparatory position for grasp involving abduction, flexion, and pronation, primarily driven by the thenar intrinsic muscles. [31] (10.1016/j.hcl.2011.09.004)
[L4] The novel tendon transfer technique maximizes adducting force and overcomes reciprocal inhibition, resulting in normal finger position at 9 months. [32] (10.1177/1753193411421096)
[L3] No significant difference was seen in hand function between border and central finger injuries, except for lower grip strength in central finger injuries. [33] (10.1177/17531934241286116)
[L4] The OP branch consistently reached the deep terminal motor branch of the ulnar nerve without tension, supporting its use to restore pinch after ulnar nerve injuries. [35] (10.1177/17531934251389494)
[L5] Tendon transfers remain the primary reconstructive procedure for paralytic injuries of the upper limb until sufficiently powered studies of nerve transfer outcomes are published. [36] (10.1177/1753193419864838)
[L5] The treatment of mutilating hand injuries in children is challenging but outcomes tend to be better than in adults regarding mobility, sensory return, and appearance. [37] (10.1016/s0749-0712(02)00076-8)
[L5] The authors welcome interest in their work on nerve transfers for complex injuries, stating that while no perfect strategies exist, nerve transfers have revolutionized care and that additional long-term follow-up and case series are warranted. [38] (10.1016/j.jhsa.2014.10.007)
[L5] The quadriga phenomenon, caused by interconnected flexor digitorum profundus tendons, significantly affects clinical situations including strength testing, movement assessment, and rehabilitation exercise selection; understanding its anatomy and biomechanics improves diagnosis and treatment. [39] (10.1177/1753193411430810)
[L4] The authors conclude that a reliable tendon prosthesis inserted as one stage in tendon reconstruction is the additional step needed to improve the results of flexor-tendon reconstructive surgery in hands with severe damage. [40] (10.2106/00004623-197153050-00001)
[L5] When nonoperative treatment fails, tendon transfers may be used, with preferred options including ECRB to AP, APL to first DI, and splint FPL to EPL transfers evaluated on an individual basis. [41] (10.1016/j.hcl.2016.03.007)
[L4] Similarly, evaluation based only on the photograph was insufficient for the detection of neurovascular bundle injuries, tendon ruptures, and fractures. [43] (10.1016/j.jhsa.2024.07.009)

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