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Nerve Damage

Started by Ken, June 10, 2014, 08:11:59 PM

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Ken

I'm wondering if others on here have experienced a nerve injury and how long their healing took.  On May 8 a small (1/4") flake of steel entered my forearm and severed what I believe they called the deep radial nerve.  Instantly I lost the ability to flex (open) my left hand.  Surgery was on May 16 to stitch the nerve.  It will be 4 weeks this Friday since the surgery but the lack of progress is maddening.  Although I've been told by both the plastic surgeon and occupational therapist that healing will be very slow I would like to hear about other experiences.   

  

 
Lots of toys for working in the bush

beenthere

Ken
That's a real bummer...  Just plain looks uncomfortable and a Dang nuisance.

No experience, or even knowledge of others in the same or similar situation. Keep looking forward to a better day.

Do the fingers have feeling, or numb? Can you move the fingers any?

And all from just a steel splinter...
What threw the steel at ya?
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thecfarm

That is too bad. What a freak thing to happen.
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Magicman

No experience here, but I wish you the best.
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doctorb

Ken-

I think I can give you a very real answers to your questions.

Nerves heal (regenerate) at a very slow rate.  After injury and repair, there is a latency period where nothing happens, as the axons within the nerve try to "refind0" the tiny "tubes" in which they lie on the far side of the injury.  Once they start to regenerate or "grow" they repair at a rate of about 1.0 mm a day.  Roughly, that's about an inch a month.  So, if your injury is at the proximal part of the forearm, some of those hand muscles are possibly 4-5 inches distal from the nerve injury.  It's going to take at least 4-5 months for those muscles to begin to be re-innervated and demonstrate recovery.  Even then, it takes more time to maximize the strength of muscles that have not been able to contract for that period of time.

It sounds like you cut the radial nerve.  This controls the dorsiflexion of the wrist and the fingers.  Think of the position that a policemen holds his wrist and fingers when he gives you the "stop" sign.  That muscle function is controlled by the radial nerve.  Do you have all the feeling in your hand or is the back of your hand near the base of the thumb numb? Now, sharp cuts of motor nerves (nerves that just innervate muscles) can be repaired and some function returns.  Dependent upon many factors (level of injury, pure motor versus a mixed sensory and motor nerve, patient age, time from injury rot repair, type of repair, associated diseases that can affect the nerves like diabetes), the degree of recovery can be variable.  So it would be wrong of you to assume that, some time in the future, you will be normal and it will be as if the injury never happened.  That's the hard truth of it.

So my bet is that your docs are going to watch this for some time.  Certainly many months.  The key for you is to be patient and to use the splints that they will provide you to keep all joints of the forearm, wrist, and hand limber.  There is little point of having a nice return of function to a hand that has been neglected with regard to passive motion and is now extremely stiff.  If little function returns, the plastic surgeons will suggest tendon transfers.  This is a surgery that uses the tendons of some of the working muscles in your forearm to improve hand function.  They do work pretty well, although, again, you do not have a normal hand as your outcome.

This is complicated stuff with which I have a fair amount of experience.  Ask all the questions you want.  If you would prefer to discuss this privately, PM me.  I do think that it would be informative to the members, but that is your decision.  Best of luck.
My father once said, "This is my son who wanted to grow up and become a doctor.  So far, he's only become a doctor."

Ken

Quote from: beenthere on June 10, 2014, 08:51:57 PM
Do the fingers have feeling, or numb? Can you move the fingers any?
And all from just a steel splinter...
What threw the steel at ya?

The steel sliver came off a track pin that I was hitting with a small hammer.  Very fluky.

doctorb  Thank you for your comments. I do still have a numbness at the base of thumb and can close my hand and grip things somewhat.  You have confirmed everything that I have heard about how long this may take and the long term prognosis  :-\.  The surgeon and therapist both seemed to indicate that I am not causing any more harm by doing whatever I can with respect to work.  Do you agree?
The splint with finger support is worn all day and a simpler one is worn at night .  Again thank you for your comments.


Lots of toys for working in the bush

doctorb

As long as there was no tendon damage that should heal first before using your hand to firmly grip, then work is OK.  The absolute key is to keep all joints, and I mean every one, in your wrist and fingers loose.  Manipulate each one separately to its maximum joint motion in both directions several times a day.

You should be able to grip pretty well, once the injury and the surgery discomfort have subsided.  The problem with this injury is opening your hand to grip something, which you currently can not do without the dynamic splint.  Once you get your hand around an object, your grip will be OK.  But powerful grip will not be normal.  When we use our hands to grip forcefully, we hold our wrists in a slightly cocked up (dorsiflexed) position.  For example, look at your wrist position as you grab a baseball bast or a hammer.  The wrist is held in  a slightly cocked up alignment.  This is the power position for the hand and wrist and is something that's controlled by the radial nerve.  Because of your injury, you can only attain this position with the splint.  If your injury was far enough below the elbow that these muscles remain innervated, then the power position of the wrist will be OK.  For fine motor movements and dexterity, we flex our wrists slightly, like when we use a knife and fork.
My father once said, "This is my son who wanted to grow up and become a doctor.  So far, he's only become a doctor."

Draco

Ken,

I had surgery that involved "avoiding" one main nerve and several smaller nerves.  It hurt like mad for months.  Then it got numb and hurt off and on.  The pain would be sharp, an ache, or in between.  The affected area radiated several inches from the incision line.  During my checkups every three months, I was assured that the nerve "impairment" would improve.  It did.  I was not allowed to call it nerve "damage".  At 15 months out, I just asked the doctor if I could expect any improvement of my still existing nerve "impairment".  He said that it may improve over the course of the next few years, or remain the way it is now.  Good luck with it.  It isn't what anybody asks for, for sure.

Ken

It has been 3 months since my posterior interrosseus nerve damage.  I was told by many (including Doctorb) it would be several months before I could expect improvement.  They weren't lying.  Although I have seen very modest gains progress is slow and discouraging.   Thanks for listening.
Lots of toys for working in the bush

clww

I've had a couple wounds and injuries that included nerve damage. First was when I broke my back. I have a small section about two inches above the imaginary line between my elbows where I have no feeling in my back. I was wounded in combat by a grenade blast, worst fragments in my right thigh. This portion has about a six inch by three inch area with no feeling, but this spot took over 250 stitches. Last one is the tip of my right pinky finger that I severed a few years ago. No feeling at all in the last half of that end section of my finger, except when it's really cold outdoors, then it really aches deep inside the bone.
I hope you heal up soon with no ill effects. :)
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thecfarm

I knew a guy from work with some nerve damage. Yep,an inch a month. It will better. Just takes time. Easy for me to say, :'( ,I'm not the one going through it. Good luck.
Model 6020-20hp Manual Thomas bandsaw,TC40A 4wd 40 hp New Holland tractor, 450 Norse Winch, Heatmor 400 OWB,YCC 1978-79

doctorb

Ken-

While very modest gains can be disappointing to patients, if these gains truly indicate that muscles that were previously not functional are beginning to function, that's wonderful news.  I know the rate of recovery is agonizingly slow, but if there are flickers of muscle control in areas where you had no function after the injury, then the radial nerve is regenerating, and further improvement should be expected.  Has your doc documented any of these changes yet?
My father once said, "This is my son who wanted to grow up and become a doctor.  So far, he's only become a doctor."

Ken

Quote from: doctorb on August 10, 2014, 09:28:21 AM
Ken-

While very modest gains can be disappointing to patients, if these gains truly indicate that muscles that were previously not functional are beginning to function, that's wonderful news.  I know the rate of recovery is agonizingly slow, but if there are flickers of muscle control in areas where you had no function after the injury, then the radial nerve is regenerating, and further improvement should be expected.  Has your doc documented any of these changes yet?

I have not had any baseline measurements yet but am supposed to meet a nerve stimulation specialist later this month as well my continued occupational therapy.  Thanks for your comments.  I was feeling sorry for myself the other night and needed to vent.
Lots of toys for working in the bush

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