It is an “indispensable, delicate and precise tool” that all of us use without batting an eyelid. But how many of us give it any thought until something happens? Even then, how many will seek immediate help, to prevent an exacerbation of impairment?
Disastrous will be the consequences of a permanent injury to the hands, for life will change drastically.
Made up of blood vessels, muscles, tendons, ligaments, bones and nerves, not only the hand but the entire limb consisting of the joint at the neck, arm, forearm and hand is of importance, says Consultant Plastic Surgeon Dr. Thushan Beneragama attached to the National Hospital, Colombo.
Referring to nerves which are vital for the functioning of the limb, Dr. Beneragama deals with the injuries and conditions that could damage them and what should be done. Nerve damage could lead to loss of sensation, cause intense pain (neuralgia) while the muscles serviced by the injured nerve could lose the electrical stimulus and become paralyzed.
“If you suffer an injury to the limb, feel the loss of sensation, numbness or pain, seek immediate medical attention,” he stresses, sounding a red alert because the more you delay, the chances of full recovery of the use of the limb could be affected.
Pointing out that in many patients early surgery could bring about the best results as soon as possible, he says that secondary or delayed procedures may not give the same result. The longer a person waits with a nerve injury, the muscles may start wasting, affecting day-to-day work.
“This,” according to Dr. Beneragama, “may lead to irreversibility, with the fine movements not only of the limb but also the delicateness of the hand being permanently affected.”
Different types of injuries or conditions may cause problems for the nerves in the entire limb, starting from the neck, the arm, the forearm and the hand, MediScene learns.
Dr. Beneragama picks out the
following:
- Trauma which may be caused by accidents, falls, cuts, stabs, stretching or sports injuries – such injuries could sever the myelin sheath around the nerve as well as the nerve or the nerve may break while the sheath remains intact. In the case of a nerve getting severed, if untreated, the nerve fibres may grow into a ball at the end of the cut forming scar tissue (neuroma) which can be very painful.
- Conditions such as Carpal Tunnel Syndrome – with repetitive action causing the ligament in the wrist to press on the nerve, carpal tunnel syndrome is common in those who use computers frequently. Here nerves get entrapped or compressed causing numbness and pain.
- Brachial Plexus injuries – affecting the network of nerves fanning out from the spine to the shoulder, arm and hand, these injuries could be caused at birth due to babies being large, prolonged labour, assisted (forceps’) deliveries, breech presentation or if the mother is suffering from diabetes or obesity. In adults, they could be caused by shoulder trauma, tumours or inflammation. In both babies and adults, the symptoms could be a weak or paralyzed arm, having no muscle control and no sensation.
With many types of surgery available to repair damaged or cut nerves in the hand and upper limb, Dr. Beneragama says that doctors would take into account the degree of the injury and the size of the gap between the separated nerve ends before taking a decision.
Explaining the power of the brain and the nerves, he says that when a nerve gets separated, the nerve-end farthest away from brain begins to die, but the nerve-end closest to the brain gets ready to re-grow.
Sometimes, however, the nerves need a little help from surgeons to cross that “gap”, MediScene understands. The help could come in the form of end-to-end approximation or grafting.
While end-to-end approximation -- generally used when there is a cut and a small gap -- would entail the stitching of the two ends of the severed nerve, a larger gap may need nerve grafting, says Dr. Beneragama. Here, a nerve section would be taken from some other place in the body and stitched to the gap in the hand. The results are predictable and good.
Nerve repair in cuts and stabs should be done as soon as possible, he urges. If the patient comes in late, then the Surgeon will have to resort to a distal nerve transfer or tendon transfer.
The answer in carpal tunnel syndrome, is to cut into the ligament and relieve the pressure on the nerve while in Brachial Plexus injuries, hand-therapy is of importance and surgery would follow if there is no improvement in the condition, says Dr. Beneragama.
After surgery the results may not be immediate, for it takes time for the nerve to grow. During this period it is essential to do hand-therapy to keep the joints soft and supple, MediScene learns.
Follow up is also important to get back a functioning hand rather than a useless hand, adds Dr. Beneragama.
Act fast
There is a special clinic at the NHSL for both children and adults who have nerve injuries.
Although earlier the thinking was that it may be
better to wait awhile for spontaneous recovery of nerve injuries, it is better to seek medical attention as soon as possible, it is learnt.
For, some with nerve injuries from neonates to adults may need surgical reconstruction sooner than later, advises Dr. Beneragama. |
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