Nerve compression syndrome is a common diagnosis. The severity of the compression depends on several factors. In this wrist and hand nerve injury continuing education course, Functional Rehabilitation of the Elbow, Wrist, and Hand, provides an in-depth analysis of the effective treatment for common wrist and hand injuries. Three of the most common compression sites are in the upper extremity: the median nerve, primarily carpal tunnel syndrome; the ulnar nerve, compression at the cubital tunnel; and not seen quite as often is the radial tunnel.
Four Types of Wrist and Hand Nerve Injuries – Continuing Education
- Compression
- Laceration
- Distraction
- Crush
The Most Common Type of Wrist and Hand Nerve Injury
The most common wrist and hand nerve injury, discussed in this continuing education course, which we see in a therapy setting is compression. Certainly, carpal tunnel falls into the compression type of nerve involvement. The variation of involvement with a nerve injury depends on the amount of pressure and time. In most cases, we understand when the injury occurs in compression, but we don’t know how much pressure there is. Certainly, we can base that on symptoms. Using some of your common assessment tools, such as monofilament testing or two-point discrimination, we can detect the amount of damage that has occurred.
Nerve compression syndrome is a common complaint in the general population. The severity of the disease can range from mild to severe.
NIH Article
Loss of Sensation
When patients describe a significant loss of sensation to the point where it is constant in feature, I have more concerns about the approaches we will apply. When we work with a patient who has had a laceration and repair, we can have mixed results, depending on the size of the nerve and the location. Small digital nerves beyond the PIP joint are often unable to be repaired, and the patient is left with permanent nerve or nerve sensation loss. When nerves are damaged proximal to the PIP joint somewhere in the hand, typically, these can be repaired with a variation of recovery. They are typically left in a protected position; MP is in a flex position.
Recovery Time
Regarding the length of recovery, traditionally, a centimeter a week to 2 weeks up to 1 inch per month for a recovery time is plausible. Again, depending on the nature of the injury, crush injuries are probably the most limited in full recovery, and distraction injuries tend to be on the better side in falling more in line with compression injuries. Compression and distraction tend to have more favorable results when we separate nerve injuries. For obvious reasons, crush and lacerations have less favorable results, with crush probably having the worst results.
Long-Term Loss of Sensation
One problem a patient can face is hypersensitivity and long-term loss of sensation in that region of damage. Loss of sensation will have to be addressed through compensatory means, typically through visual inspection of areas that cannot detect sharp and dull objects. Also, be aware of heat and certainly cold in the damaged region, with heat being more likely to have issues.
Learn more about Wrist and Hand Nerve Injury in our All Access Continuing Education Subscription
The Healthclick All Access Online Series in our new All Access Annual Subscription contains a variety of upper extremity orthopedic courses to Improve function. Check out some other courses within the orthopedic series:
Elbow, Wrist, and Hand Injury and Orthotic Fabrication
Injury Prevention and Optimal Mechanics in the Throwing Athlete
Critical Analysis and Treatment Strategies for the Complex Shoulder
Foundation Exercises for the Treatment of the Shoulder
Learn more about our All Access Annual Subscription
References
Chauhan M, Anand P, M Das J. StatPearls [Internet]. StatPearls Publishing; Treasure Island (FL): Aug 25, 2021. Cubital Tunnel Syndrome.
Doughty CT, Bowley MP. Entrapment Neuropathies of the Upper Extremity. Med Clin North Am. 2019 Mar;103(2):357-370.
Glover NM, Murphy PB. StatPearls [Internet]. StatPearls Publishing; Treasure Island (FL): Jul 27, 2021. Anatomy, Shoulder and Upper Limb, Radial Nerve.
Sevy JO, Varacallo M. StatPearls [Internet]. StatPearls Publishing; Treasure Island (FL): Sep 10, 2021. Carpal Tunnel Syndrome.
