Principles of Management of Nerve and Tendon Injuries of the Hand 1. Assessment and Diagnosis: Nerve Injuries: • • Clinical Evaluation: Detailed history of the injury, assessment of motor and sensory deficits, and examination for signs such as Tinel's sign (tingling sensation) or loss of function. Diagnostic Tests: Nerve conduction studies (NCS) and electromyography (EMG) to assess nerve function and locate injury sites accurately. Tendon Injuries: • • Clinical Evaluation: Assessment of the mechanism of injury, ability to move fingers or thumb, and observation for deformities like bowstringing. Diagnostic Tests: Sometimes imaging like ultrasound or MRI to evaluate tendon integrity and confirm the extent of injury. 2. Acute Management: Nerve Injuries: • • • • Protective Measures: Immobilization of the limb to prevent further damage and protect the injured nerve. Surgical Intervention: Early repair of nerve injuries is crucial, especially for cleancut injuries or those with significant functional deficit. Grafting: For longer nerve gaps, nerve grafts (autografts or allografts) may be necessary to bridge the defect. Tendon Transfers: In cases of severe nerve injury with irreversible loss of function, tendon transfers may be considered to restore some degree of function. Tendon Injuries: • • • • Repair: Primary repair of tendons is essential within a critical window (typically within 1-2 weeks) to prevent adhesions and promote optimal healing. Techniques: Techniques such as modified Kessler or four-strand core suture are used for repair, depending on the specific tendon involved. Protective Splinting: Immobilization of the repaired tendon with a splint to allow healing while preventing stress on the repair site. Early Mobilization: Gradual and controlled mobilization under the guidance of a hand therapist to prevent stiffness and promote tendon gliding. 3. Rehabilitation and Postoperative Care: Nerve Injuries: • • • Rehabilitation Program: Initiate early mobilization and range of motion exercises to prevent joint stiffness and promote nerve regeneration. Sensory Re-education: Techniques such as desensitization exercises to improve sensory function in nerve-injured areas. Monitoring: Regular follow-up to assess progress, manage complications like neuromas or scar tissue formation, and adjust rehabilitation protocols. Tendon Injuries: • • • Postoperative Immobilization: Splinting or casting to protect the repaired tendon and allow initial healing. Progressive Mobilization: Controlled and supervised rehabilitation to gradually increase range of motion and strength. Staged Rehabilitation: Depending on the tendon involved, specific protocols for flexor or extensor tendons to ensure optimal outcomes. 4. Complications and Management: Nerve Injuries: • • Neuromas: Formation of painful nerve nodules at the injury site may require surgical excision or treatment with medications. Loss of Function: In cases of incomplete recovery, ongoing rehabilitation and adaptive strategies (e.g., assistive devices) may be necessary. Tendon Injuries: • • Adhesions: Formation of scar tissue around tendons may limit mobility and require interventions such as passive stretching or surgical release. Rerupture: Reinjury of repaired tendons due to premature return to activities or inadequate rehabilitation; requires surgical revision. 5. Long-term Management and Prognosis: Nerve Injuries: • • Prognosis: Recovery depends on the severity of injury, timing of intervention, and patient compliance with rehabilitation. Some patients may achieve near-normal function, while others may have residual deficits. Functional Goals: Focus on maximizing sensory and motor function to restore hand function and quality of life. Tendon Injuries: • • Prognosis: Successful outcomes are possible with early, anatomical repair and diligent rehabilitation. Return to pre-injury activities depends on the tendon involved and adherence to rehabilitation protocols. Functional Goals: Restore strength, flexibility, and coordination necessary for daily activities and occupational demands. Conclusion: Effective management of nerve and tendon injuries of the hand requires a comprehensive approach involving timely diagnosis, surgical intervention when indicated, meticulous repair techniques, and structured rehabilitation. Close collaboration between surgeons, therapists, and patients is crucial to achieving optimal functional outcomes and minimizing long-term disability.