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手部肌腱与神经损伤

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Hand tendon and nerve injuries – understanding symptoms, diagnosis, and treatment options.

Updated Jun 2026
一幅手绘插图，展示手部肌腱和神经切割伤的手术修复。
手掌侧的肌腱和神经位于靠近皮肤的狭窄通道内。切割伤和裂伤通常涉及多个结构。 Kieran Hirpara 4.0

本页面由机器翻译，尚未经临床医生审核。英文版本为权威版本。

您的感受

您可能会注意到手部或手腕出现疼痛、麻木或无力。这通常发生在受伤之后。如果您遭受了弹道损伤（如枪伤），骨折的存在会增加神经和肌腱同时受损的可能性。这种组合会增加长期残疾的风险。您还可能在神经损伤部位附近感到一个疼痛的肿块。这被称为神经瘤。它可能非常不适，并使日常活动变得困难。

简单的动作可能会变得困难。您可能难以抓握物体、伸手到背后扣内衣扣，或将衬衫塞进裤子里。如果您患有扳机指，当您尝试伸直手指时，手指可能会卡住或锁定。这在儿童中很常见，但任何年龄都可能发生。疼痛通常在活动后或早晨刚醒来时加剧。您可能会发现难以在疼痛的一侧侧卧睡觉。

您的外科医生会寻找神经损伤的迹象。只有 24% 的修复神经能够恢复接近或等同于受伤前估计水平的感觉功能。这意味着即使手术后，您可能也无法完全恢复感觉。如果您患有高位桡神经损伤且缺损达到或超过九厘米，时间至关重要。在继续进行肌腱转移之前，尝试神经重建在 8 个月内似乎是适应证。如果无法进行修复，肌腱转移是恢复功能的有用选择。

手部和手腕的肌腱病很常见。您可能会感到酸痛或僵硬，并且在使用时加重。大多数人的治疗方式相似，包括逐步推进非手术和手术治疗。如果您有可能导致神经损伤的受伤模式，及时转诊至上肢专科医生对于优化预后非常重要。不要等待症状自行缓解。早期护理有助于预防进一步的并发症并支持更好的恢复。

实际发生了什么

您的手部依赖于一个由肌腱和神经组成的复杂系统，它们协同工作。肌腱就像强韧的绳索，将肌肉连接到骨骼上，使您能够抓握和释放物体。神经则充当电线，将信号从大脑发送出去，告知肌肉何时以及如何运动。当这些结构受损时，通信就会中断，机械连接也会减弱。

在许多情况下，您的外科医生可能会建议进行肌腱转移术。该手术将健康的肌腱移动到受损或不再起作用的位置以替代原肌腱。当修复原神经无法恢复有用功能，或神经损伤过于严重而无法直接修复时，这是一种有用的选择。通过重新路由这些“绳索”，您的外科医生可以恢复关键动作，例如伸展拇指或抓握物体。这种方法通常有助于您比等待神经自行愈合更快地重返工作和日常生活。

神经损伤还会干扰感觉和肌肉控制。对于拇指或指尖修复，恢复感觉至关重要，占治疗目标的40%，而长度和外观占其余50%。如果神经断裂且间隙达到或超过九厘米，您的外科医生可能会在考虑肌腱转移术之前，尝试在八个月内进行神经重建。在某些情况下，将神经修复与肌腱转移相结合，其功能效果优于单独进行任何一种手术。

即使力量或活动范围降低，手部功能仍可保持良好。您可能会发现抓握小物体比抓握大物体更困难，且与另一侧相比，患手的伸展力量可能低约20%。然而，尽管存在这些身体限制，临床评分通常显示结果良好。您的外科医生通过仔细的体格检查和影像学检查来准确诊断问题，旨在限制僵硬的同时尽可能保留活动度。

我们能采取的措施

您的外科医生将首先评估损伤程度，以确定最佳的治疗方案。对于许多神经和肌腱问题，非手术治疗是首选的起点。您可能被建议休息手部，并避免引起疼痛的活动。物理治疗在这一阶段起着关键作用。其目的是在组织愈合期间保持关节活动度并防止僵硬。在某些情况下，如非创伤性骨间后神经麻痹，建议尝试非手术治疗。您应密切监测肌力。如果在观察6周后未见肌肉恢复迹象，或出现进行性肌无力，您的外科医生可能会建议进一步检查或手术。

药物治疗侧重于控制疼痛和减轻炎症，以帮助您进行日常活动。您的外科医生可能会开具止痛药或抗炎药。对于特定疾病，如儿童扳机指，肌腱鞘松解术疗效确切，且复发或神经损伤的风险极低。在神经受压的情况下，如桡浅神经问题，神经松解术（解除对神经的压力）可能有助于缓解疼痛，但疗效并不保证。对于肌腱损伤，早期就诊且伤口清洁者可行一期修复。如果伤口污染或就诊较晚，则建议采用肌腱移植进行二期修复。您的外科医生将使用MRI或超声等影像学检查来规划这些治疗，并检查是否存在肌腱分离或嵌顿等问题。

当保守治疗无法恢复功能或损伤严重时，会考虑手术治疗。对于桡神经损伤，当神经修复不可能或失败时，肌腱转移是恢复运动功能的有效选择。如果早期重返工作岗位至关重要，这可能成为首选手术。对于伴有9厘米或更大缺损的高位桡神经损伤，您的外科医生可能会在考虑肌腱转移之前，尝试在8个月内进行神经重建。对于指神经损伤，单期修复后获得良好恢复的证据较差，仅有24%的修复神经恢复了接近受伤前水平的感觉。在涉及四肢瘫的复杂病例中，可联合使用神经和肌腱转移来恢复抓握和释放功能，尽管需要更多研究来证实优越性。您的外科医生将权衡恢复功能的好处与供体神经风险及未来选择之间的关系。

预期情况

您的恢复取决于具体的损伤类型及所选择的治疗方案。如果您的外科医生进行了神经修复，您需要了解感觉功能的完全恢复并不能得到保证。仅有 24% 的修复神经能够恢复至接近或等同于受伤前的感觉水平。这意味着大多数人将遗留一定程度的持续性感觉改变。然而，对于高位桡神经损伤，若能在六个月内进行修复、缺损长度小于五厘米，或使用三根或更多供体神经束进行移植，则预后较好。

如果无法进行神经修复，或修复后未能恢复有用功能，您的外科医生可能会建议进行肌腱转移术。该手术通过将健康肌腱重新定向来替代丧失的运动功能。这是治疗桡神经、正中神经或尺神经损伤的有效选择。对于桡神经麻痹，与神经移植或神经移植术相比，肌腱转移术通常能提供更优越的临床结果。如果您优先考虑尽早重返工作岗位和社会活动，这种方法尤为重要。在某些情况下，将神经修复与肌腱转移术联合应用并未显示不良后果，且可能比单独进行肌腱转移术带来更好的功能改善。

愈合需要时间。对于伴有九厘米或更大缺损的高位桡神经损伤，应在进行肌腱转移术之前，于八个月内尝试进行神经重建。如果您接受了原发性肌腱修复，早期主动活动有益，且效果优于旧式方法。大多数患者在随访期间功能均有显著改善。虽然可能出现感染或僵硬等并发症，但严重问题并不常见。大多数不良后果为短期疼痛和肿胀。您应预期力量和感觉逐渐恢复，具体时间线因初始损伤的严重程度及所接受的具体手术而异。

何时就诊

如果出现休息后仍不缓解的持续性疼痛，或手部出现无力和不稳，请寻求专科医生评估。若手部出现交锁、无力或症状干扰睡眠或工作，请及时就医。症状突然加重也应立即就诊。证据表明，骨折与神经和肌腱损伤风险增加相关，可能导致长期残疾。早期评估有助于优化预后。若怀疑存在神经损伤，及时转诊对于恢复功能并预防疼痛性神经瘤或永久性感觉丧失等并发症至关重要。

Reviewed by AI synthesis (v2) — pending human review · 18 May 2026.

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Evidence & references

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

  • 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].
  • 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

  • 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].
  • 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].
  • Ballistic injuries to the hand are frequently associated with fractures and neurovascular and tendon injuries [4].
  • 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

  • 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].
  • High median nerve transection can present with preserved finger flexion [2].
  • Ballistic injuries to the hand are frequently associated with fractures and neurovascular and tendon injuries [4].
  • 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].
  • 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

  • Ballistic injuries to the hand are frequently associated with fractures and neurovascular and tendon injuries [4].
  • 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

  • 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].
  • 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].
  • 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].
  • 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].
  • 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].
  • 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

  • Ballistic injuries to the hand are frequently associated with fractures and neurovascular and tendon injuries [4].
  • Spontaneous recovery occurs in 70%–88% of radial nerve injuries [17].
  • 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].
  • Nerve transfers have revolutionized care for peripheral nerve injuries [38].

Recovery

  • 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].
  • Ballistic injuries to the hand are frequently associated with fractures and neurovascular and tendon injuries [4].
  • 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].
  • 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].
  • 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].
  • Spontaneous recovery occurs in 70%–88% of radial nerve injuries [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].
  • 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].
  • Nerve transfers have revolutionized care for peripheral nerve injuries [24].
  • 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)

References

[1] Management of Ulnar Nerve Injuries. The Journal of Hand Surgery. 2015. DOI: 10.1016/j.jhsa.2014.04.038 [2] Preserved finger flexion following high median nerve transection: a rare case report and review of literature. BMC Musculoskeletal Disorders. 2025. DOI: 10.1186/s12891-025-08469-3 [3] Tendon versus nerve transfers – balancing hand function in upper extremity high nerve injuries. Journal of Hand Surgery (European Volume). 2026. DOI: 10.1177/17531934261416300 [4] Outcomes in Ballistic Injuries to the Hand: Fractures and Nerve/Tendon Damage as Predictors of Poor Outcomes. HAND. 2022. DOI: 10.1177/15589447221092111 [5] Nerve Transfer Versus Nerve Graft for Reconstruction of High Ulnar Nerve Injuries. The Journal of Hand Surgery. 2017. DOI: 10.1016/j.jhsa.2017.01.027 [6] Distal Sensory Nerve Transfers in Lower-Type Injuries of the Brachial Plexus. The Journal of Hand Surgery. 2012. DOI: 10.1016/j.jhsa.2012.02.047 [7] Experimental sensory reinnervation of the median nerve by nerve transfer in monkeys. The Journal of Bone & Joint Surgery. 1977. DOI: 10.2106/00004623-197759030-00016 [8] Exploring 20 years of peripheral nerve injuries of the upper extremity: An analysis of median, radial, and ulnar nerve injuries presenting to US emergency departments. Journal of Hand Therapy. 2026. DOI: 10.1016/j.jht.2026.02.012 [9] Nerve Transfer for Restoration of Ulnar Fingers Flexion Through Pronator Teres Motor Branch: A Cadaveric Feasibility Study. Journal of Hand Surgery Global Online. 2026. DOI: 10.1016/j.jhsg.2025.100844 [10] Biomechanics and hand trauma: what you need. Hand Clinics. 2003. DOI: 10.1016/s0749-0712(02)00130-0 [11] Avulsion Injuries to the Brachial Plexus and the Value of Motor Reinnervation by Ipsilateral Nerve Transfer. Journal of Hand Surgery. 2000. DOI: 10.1054/jhsb.2000.0460 [12] End-to-side Distal Anterior Interosseous Nerve Transfer in Treatment of Proximal Ulnar Nerve Injuries. The Journal of Hand Surgery. 2011. DOI: 10.1016/s0363-5023(11)60008-7 [13] The Triad of Multiple Metacarpal Fractures and/or Dislocations of the Fingers, Severe Hand Swelling and Clinical Evidence of Acute Median Nerve Dysfunction. Journal of Hand Surgery (European Volume). 2008. DOI: 10.1177/1753193408087105 [14] Vascularized Ulnar Nerve Graft for Reconstruction of a Large Defect of the Median or Radial Nerves After Severe Trauma of the Upper Extremity. The Journal of Hand Surgery. 2005. DOI: 10.1016/j.jhsa.2005.03.017 [15] Severe hand injuries resulting from Samurai sword assaults: a Dublin case series. Journal of Hand Surgery (European Volume). 2010. DOI: 10.1177/1753193410381576 [16] Nerve Transfer to the Median Nerve Using Parts of the Ulnar and Radial Nerves in the Rabbit – Effects on Motor Recovery of the Median Nerve and Donor Nerve Morbidity. Journal of Hand Surgery. 2000. DOI: 10.1054/jhsb.2000.0389 [17] Timing of surgery in peripheral nerve injury of the upper extremity. Journal of Hand Surgery (European Volume). 2024. DOI: 10.1177/17531934241240867 [18] High Ulnar Nerve Injuries. Hand Clinics. 2016. DOI: 10.1016/j.hcl.2015.12.009 [19] Direct Radial to Ulnar Nerve Transfer to Restore Intrinsic Muscle Function in Combined Proximal Median and Ulnar Nerve Injury: Case Report and Surgical Technique. The Journal of Hand Surgery. 2014. DOI: 10.1016/j.jhsa.2014.04.013 [20] Nerve grafts bridging the thenar branch of the median nerve to the ulnar nerve to enhance nerve recovery: a report of three cases. Journal of Hand Surgery (European Volume). 2016. DOI: 10.1177/1753193416675069 [21] A new model instrument for outcome after nerve repair. Hand Clinics. 2003. DOI: 10.1016/s0749-0712(03)00003-9 [22] Peripheral neuropathies associated with total hip arthroplasty. The Journal of Bone & Joint Surgery. 1976. DOI: 10.2106/00004623-197658010-00011 [23] Response to “Direct Radial to Ulnar Nerve Transfer to Restore Intrinsic Muscle Function in Combined Proximal Median and Ulnar Nerve Injury: Case Report and Surgical Technique”. The Journal of Hand Surgery. 2015. DOI: 10.1016/j.jhsa.2014.10.067 [24] Letter to the Editor Regarding Phillips BZ, Franco MJ, Yee A, Tung TH, Mackinnon SE, Fox IK. Direct Radial to Ulnar Nerve Transfer to Restore Intrinsic Muscle Function in Combined Proximal Median and Ulnar Nerve Injury: Case Report and Surgical Technique. J Hand Surg Am. 2014;39(7):1358–1362. The Journal of Hand Surgery. 2015. DOI: 10.1016/j.jhsa.2014.07.058 [25] High Median Nerve Injury. Hand Clinics. 2016. DOI: 10.1016/j.hcl.2015.12.008 [26] Updates on and Controversies Related to Management of Radial Nerve Injuries. Journal of the American Academy of Orthopaedic Surgeons. 2019. DOI: 10.5435/jaaos-d-17-00325 [27] Supercharged end-to-side anterior interosseous nerve transfer to restore intrinsic function in high ulnar nerve injury: a prospective cohort study. BMC Musculoskeletal Disorders. 2024. DOI: 10.1186/s12891-024-07650-4 [28] Low Median Nerve Transfers (Opponensplasty). Hand Clinics. 2016. DOI: 10.1016/j.hcl.2016.03.005 [29] Clinical and user-friendly classification of traumatic digital nerve injuries of hand. Archives of Orthopaedic and Trauma Surgery. 2007. DOI: 10.1007/s00402-007-0299-6 [30] Ulnar Nerve to Musculocutaneous Nerve Transfer in an Ulnar Ray–Deficient Infant With Brachial Plexus Birth Palsy: Case Report. The Journal of Hand Surgery. 2010. DOI: 10.1016/j.jhsa.2010.06.014 [31] Restoration of Opposition. Hand Clinics. 2012. DOI: 10.1016/j.hcl.2011.09.004 [32] Correcting the persistently abducted little finger using a distally based extensor digiti minimi tendon. Journal of Hand Surgery (European Volume). 2011. DOI: 10.1177/1753193411421096 [33] Long-term subjective and objective outcomes after digital nerve repair: a cohort study. Journal of Hand Surgery (European Volume). 2024. DOI: 10.1177/17531934241286116 [35] Anatomical roadmap of the thenar motor branches: key insights for distal nerve transfers. Journal of Hand Surgery (European Volume). 2025. DOI: 10.1177/17531934251389494 [36] Tendon transfers after peripheral nerve injuries: my preferred techniques. Journal of Hand Surgery (European Volume). 2019. DOI: 10.1177/1753193419864838 [37] Pediatric mutilating hand injuries. Hand Clinics. 2003. DOI: 10.1016/s0749-0712(02)00076-8 [38] In Reply:. The Journal of Hand Surgery. 2015. DOI: 10.1016/j.jhsa.2014.10.007 [39] The quadriga phenomenon: a review and clinical relevance. Journal of Hand Surgery (European Volume). 2011. DOI: 10.1177/1753193411430810 [40] Flexor-Tendon Reconstruction in Severely Damaged Hands. The Journal of Bone & Joint Surgery. 1971. DOI: 10.2106/00004623-197153050-00001 [41] Ulnar Nerve Tendon Transfers for Pinch. Hand Clinics. 2016. DOI: 10.1016/j.hcl.2016.03.007 [43] Evaluation of Injured Structures and Circulation of Fingers From Photos Taken in the Emergency Department After Hand Injury. The Journal of Hand Surgery. 2024. DOI: 10.1016/j.jhsa.2024.07.009 [44] Flexor-Tendon Grafts in the Fingers and Thumb: A STUDY OF FACTORS INFLUENCING RESULTS IN 1000 CASES.. The Journal of Bone and Joint Surgery. American Volume. 1971.

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