Treatment overview
Peripheral nerve injuries of the hand and upper limb cause loss of sensation, weakness, and fine motor impairment that can be profoundly disabling. At Olive Skin & Aesthetics, we manage the full spectrum of hand nerve injuries — from simple digital nerve lacerations to complex median, ulnar and radial nerve injuries at the wrist and forearm — using microsurgical repair, nerve grafting, and conduit techniques to restore the best possible functional outcome.
The prognosis for nerve recovery depends critically on the level of injury, the patient’s age, the time elapsed since injury, and the quality of the repair. Early microsurgical intervention offers the best chance of meaningful sensory and motor recovery — making prompt referral and surgical timing among the most important factors in final outcome.
- Patients with acute digital, median, ulnar, or radial nerve injuries of the hand, wrist, or forearm
- Individuals with nerve crush or traction injuries requiring exploration and repair
- Those with neuroma formation causing chronic pain at a prior nerve injury site
- Patients with motor or sensory deficit following injury to a limb, warranting surgical intervention
- Adults presenting in a delayed manner where nerve transfer or tendon transfer may offer better functional recovery than direct repair
Nerve repairs are performed under tourniquet control using loupe magnification or an operating microscope for digital nerve repairs. The cut nerve ends are trimmed back to healthy fascicular tissue, then repaired end-to-end using 9-0 or 10-0 nylon epineural sutures — aiming for a tension-free coaptation that aligns fascicular groups accurately.
Where a gap exists that prevents tension-free direct repair, a nerve graft harvested from the same limb or leg is interposed. For sensory digital nerves, commercially available collagen nerve conduits offer a viable alternative to autograft for gaps up to 30 mm. Complex motor nerve injuries — such as high median, ulnar or radial nerve injuries — may require adjunct tendon transfers to restore critical hand function while awaiting nerve regeneration.
- Days 1–7: Splint protecting the repair site. Hand elevation and wound care.
- Week 1–3: Sensory re-education programme commenced with hand therapist once wound is healed.
- Month 1–3: Tinel’s sign progression monitored to track advancing nerve regeneration (approximately 1 mm/day).
- Month 3–6: Protective sensation returns in distal territories. Graded sensory re-education intensified.
- Month 6–18: Progressive improvement in two-point discrimination and fine sensation. Motor recovery for proximal repairs assessed at 12–18 months.
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