Hand Injury / Tendon and Nerve Repair | Existing website questions

Nerve injuries in the hand and fingers are complex and do not recover as well as ligaments, tendons or bones. Despite optimal treatment, many nerve injuries result in some permanent dysfunction. In very severe cases, when even the outer nerve layer is damaged, surgery may be needed for meaningful recovery. Hand trauma varies: burns and skin loss may need flaps or grafts, while traumatic digit loss may need toe-to-hand surgery. Tendon injuries also need repair and careful rehabilitation, and tendon injuries can profoundly affect hand function, so appropriate therapy is essential. Primary hand trauma treatment often requires microsurgical facilities for small vessel and nerve repair.

Open nerve injuries should be operated within the initial hours. In an emergency setting, the surgeon can best approximate nerve endings and evaluate fascicular organization and epineural vascularization; the nerve ends appear as mirror images. Associated injuries are common, and revascularization of the nerve and surrounding tissues decreases epi- and perineural sclerosis from scarring, preserving gliding. Primary repair is the gold standard; delayed repair may require trimming and renewed degeneration. Nerves grow about one inch monthly, while motor end plates suffer fallout over time, so earlier repair lessens time to functional return and may improve motor recovery. Tendon repair strength is the mechanical basis for early mobilization and biological healing.

Nerves are complex and do not recover as well as ligaments, tendons, or bones, so even optimal treatment may leave some permanent dysfunction. Repair aims for precise, tension-free alignment of nerve ends; for small nerves a microscope helps the surgeon see and repair the outer nerve covering. When a gap prevents direct alignment, a graft or conduit may be used, but the choice depends on injury mechanism, nerve type, and tissue quality. Tendon or vessel injuries are often addressed before nerve repair. Rehabilitation may take months and coordination between surgeon and therapist is important. Sensation recovery is gradual and not guaranteed. The surgeon may use fine sutures under magnification. Outcomes vary by injury.

Tendon rehabilitation is traditionally divided into three phases, each lasting about three weeks: initial immobilization, early passive range of motion, then active range of motion. A strong surgical repair supports early mobilization. Early passive motion protects the repair while allowing tendon gliding; active motion follows once healing permits. Nerves are complex and often recover less well than tendons, ligaments or bones; despite optimal treatment, many nerve injuries leave some permanent dysfunction. Postoperative therapy may progress over two to three months for flexibility and strength. Outcomes depend on injury severity, repair quality and adherence. Your surgeon and therapist tailor the exact plan to your injury and repair. Rehabilitation should not be rushed, because protecting the repair matters.

Suitability depends on whether the injury is a clean cut or a crush, how much tissue is damaged, the amputated part's condition, and the patient’s overall health. Replantation is generally avoided after more than 12 hours of cold ischemia or 6 hours of warm ischemia. Thumb replantation often offers the best functional return; injuries distal to the FDP insertion usually do well, while single-finger zone II injuries are rarely indicated except for the thumb. Multiple amputations, hand-level injuries and children may be considered. Severely crushed, degloved or very distal nail-bed injuries, and serious systemic illness, are generally less suitable. An experienced physician should determine prognosis.

Hand trauma can involve tendons, nerves and blood vessels together. BAPRAS notes primary treatment often needs microsurgical facilities for small vessel and nerve repair, available around the clock. Combined injuries are common, so assessment may include movement, sensation and blood flow, and repair planning is case-specific. Insurance decisions still depend on policy wording, exclusions and insurer approval. The team helps with clinical documentation and pre-authorisation or reimbursement paperwork, and coordinates eligible hospital cashless claims subject to insurer prior approval, but cannot promise coverage, approval or cashless eligibility. Timely specialist assessment matters after urgent injury. Dr. Vishal Purohit can explain relevant procedure options, suitability, benefits and limitations during consultation.

The median nerve travels through a narrow wrist passage; swelling or thickening can compress it, causing pain, tingling, numbness, weakness or aching. Symptoms may worsen at night. Diagnosis may include nerve tests in both wrists and neck X-rays to exclude cervical nerve involvement or other causes. Surgery does not remove the nerve; it opens the tight roof so the nerve has more room. Some surgeons use an endoscope, but Dr. Purohit’s confirmed approach is open or mini-open release. In selected cases, scar around the nerve or tendon bursa may also be addressed. Relief can be immediate or take up to three months, and some ache may linger.

Late reconstruction follows the same principles as adult repair: stable bones, intact or rebuilt guiding bands, an open tendon tunnel and a stable soft-tissue cover. Good results can be achieved even after years of delay between injury and reconstruction. It usually needs more than one operation, first a temporary spacer, then a tendon graft. Nerve injury or suspected nerve injury is the reason to assess sooner. Combined tendon and nerve injuries are common, and extensive tissue damage may need careful cleaning before repair. Outcomes depend on surgical skill and injury mechanism; clean cuts differ from crushing injuries. Rehabilitation must protect the repair while allowing controlled motion, with surgeon and therapist coordination.

Hand trauma can involve tendons, nerves and small vessels together, so repair planning must protect movement, feeling and blood supply. BAPRAS notes that primary hand trauma treatment often needs microsurgical facilities for small vessel and nerve repair. AAOS notes that even with optimal treatment, many nerve injuries cause some permanent dysfunction. Tendon repair strength must allow early controlled motion while limiting adhesions, and rehabilitation should be coordinated with the surgeon. Clean cuts and crush injuries differ in exposure, swelling and adhesion risk. The exact plan depends on which structures are injured and how they were damaged. Dr. Purohit can explain these trade-offs during consultation, without promising a specific method.