Disorders of the Hand: Hand Reconstruction and Nerve Compression (PDF)

Author: Ian A. Trail/Andrew N.M. Fleming Published year: 2015 Downloads: 5
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Background - Aetiology

The hand has been called an extension of the brain, and the sensory and motor performance of the hand is based on the adequate function of components in the peripheral as well as the central nervous system. From a hand surgery perspective, poor functional outcomes after peripheral nerve lesions represent a frustrating problem.

Injuries to peripheral nerves are common in all forms of upper extremity trauma but the management of them remains a challenge. Common causes include lacerations, fractures, dislocations, ligamentous tears, crush and amputation injuries. Injuries are most often caused by domestic or industrial accidents or interpersonal violence. Nerve injuries range from nerve compression lesions, like carpal tunnel syndrome, up to severe rupture and avulsion of spinal nerve roots of the brachial plexus (BP). Males suffer traumatic nerve injuries at a ratio of 2.2:1 compared with females [4]. The typical patient who sustains a nerve laceration is a male in his late teens or early twenties.

As a protective instinct, the arm, forearm and hand are frequently outstretched during injury. The upper extremity therefore often absorbs the initial impact, with the dominant arm involved slightly more frequently. The most frequently injured nerves are the radial nerves of the index finger, the ulnar digital nerves of the small finger, and the median and ulnar nerves at the wrist level [5]. 

As far as BP injuries are concerned, high-velocity motor vehicle accidents account for the majority of the cases; most studies report that motorcycle accidents are responsible approximately twice as often as automobile accidents. Nerve injuries in these cases are from traction and compression, with traction accounting for 95 % of injuries. Other common causes include (in different percentages according to different studies) industrial accidents, pedestrian-vehicle accidents, snowmobile accidents, gunshot wounds, and other penetrating injuries [6].

Only around 3 % of hand injuries include injury to peripheral nerve trunks. Even a minor injury to a finger causing a digital nerve injury (incidence 6.2/100,000 inhabitants/year) may induce dysfunction of the hand. The consequences of a median or ulnar nerve injury in the forearm are even more wide-ranging for the patient. The injury does not only cause problems in the patient’s professional life but leisure activities are also severely impaired.

The overall incidence of BP injuries in multi-trauma patients secondary to motor vehicle accidents ranges from 0.67 to 1.3 % [7]. This number increases to 4.2 % for victims of motorcycle accidents. This difference can easily be explained by the increased forces applied to the BP of the unprotected body during a high-velocity motorcycle accident.
 

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