Nerve Injury
Restoration of Upper Extremity Joint Function Following Disabling Injuries including Brachial Plexus Injuries
Nerves are fragile and can be damaged by pressure, stretching, or cutting. Injury to a nerve can stop the transmission of signals to and from the brain, preventing muscles from working and causing loss of feeling in the area supplied by that nerve.
To fix a cut nerve, the insulation around both ends of the nerve is sewn together. A nerve in a finger is only as thick as a piece of thin spaghetti, so the stitches have to be very tiny and thin. The repair may need to be protected with a splint for the first 3 weeks to protect it from stretching apart since it is so delicate.
The goal in fixing the nerve is to repair the outer cover so that nerve fibers can grow down the empty tubes to the muscles and sensory receptors and work again.
Figure A: Nerve with bundles of individual nerve fibers and surrounding outer sheath (“insulation”)
Figure B: Nerve repair with realignment of bundles with the aid of microscope
Nerve can recover after a good repair and grows at an average rate of about 1mm per day.
Figure C: Radial nerve injury withinability to extend the wrist and fingers
Figure D: Exploration showed the radial nerve was cut with loss of the nerve substance
Figure E: Nerver grafting was done
Figure F: Microscopic picture of the nerve repair
Figure G: 1 year post-surgery showing full extension and flexion of the wrist
