Hand Nerve and Tendon Injuries: Recovery Insights

Hand nerve and tendon issues?

Two weeks ago, I sustained a laceration to the artery, tendon, and median nerve on the inner side of my wrist due to broken glass.
The doctor described the wound as extensive, and X-rays confirmed that there was no bone injury.
My first concern is that since the surgery until today, my wound has never produced any spontaneous pain; I only feel a slight discomfort when changing the dressing.
I find this unusual because such a severe injury typically causes significant pain requiring analgesics.
However, my attending physician mentioned that pain perception varies from person to person, but it seems unlikely to have no pain at all, right?
My second concern is during the dressing change, the doctor asked me to move my thumb aside to wrap the bandage, but I realized I couldn't move it backward at all.
According to the doctor, I should be able to move my thumb like giving a thumbs-up, but I am unable to do so.
Currently, I am in the outpatient clinic for plastic surgery; should I seek another specialty to evaluate the nerves in my hand and thumb?
My third concern is whether I should start rehabilitation therapy on my own or wait until the wound is completely healed before being referred to a rehabilitation specialist?

KK, 20~29 year old female. Ask Date: 2019/07/10

Dr. Wang Zhaomin reply Rehabilitation

1.
Pain perception indeed varies from person to person; sometimes, as reported, pain is only felt when there is a pulling sensation.

2.
Plastic surgery can appropriately address hand injuries; however, if there are concerns, seeking a second opinion from a neurosurgeon is advisable.

3.
Since the extent of injuries varies among individuals, the process of tendon and nerve repair may also present unique situations that require individual attention.
The attending surgeon should have the best understanding of the actual condition, so it is recommended to discuss with the original surgeon before proceeding with rehabilitation treatment.

Reply Date: 2019/07/10

More Info

Injuries to the hand, particularly those involving nerves and tendons, can be complex and often require careful management and rehabilitation. Based on your description, it sounds like you've experienced a significant injury involving the median nerve, which is crucial for hand function, particularly in thumb movement. Let's address your questions and concerns systematically.

Pain Perception Post-Surgery
Firstly, regarding your lack of pain sensation in the two weeks following surgery, it is important to understand that pain perception can indeed vary significantly from person to person. The absence of pain does not necessarily indicate a problem, especially if the surgical site is healing well and there are no signs of infection. However, it is unusual for a severe injury to be completely painless. The fact that you feel some discomfort during dressing changes suggests that there is still some sensitivity in the area, which is a positive sign of nerve function. It is essential to communicate your concerns with your surgeon, as they can provide insights based on your specific case and the extent of your injury.

Thumb Mobility and Nerve Function
Your second concern about the inability to move your thumb is particularly important. After a nerve injury, it is common to experience weakness or paralysis in the affected area. The median nerve controls several muscles in the hand, including those that allow thumb movement. If you are unable to move your thumb as instructed by your doctor, it may indicate that the nerve has not yet regained function or that there is still significant swelling or immobilization affecting your range of motion. It is advisable to follow up with a specialist in hand surgery or a neurologist to assess the status of your nerve recovery. They may recommend diagnostic tests, such as nerve conduction studies, to evaluate the extent of nerve damage and recovery.

Rehabilitation Timing
Regarding your question about when to start rehabilitation, it is generally recommended to begin rehabilitation as soon as it is safe to do so, even if the wound is not fully healed. Early mobilization can help prevent stiffness and promote better functional recovery. However, the timing and type of rehabilitation should be guided by your surgeon or a rehabilitation specialist. They will consider factors such as the healing of your surgical site, the extent of nerve damage, and your overall health status. If your doctor has not yet referred you to a rehabilitation specialist, it would be prudent to discuss this with them during your next appointment.

Additional Considerations
In addition to these points, it is essential to maintain a positive mindset during your recovery. Hand injuries can be frustrating, especially when they affect your daily activities and quality of life. Engaging in supportive therapies, such as occupational therapy, can be beneficial. These therapies focus on improving hand function and adapting to any limitations you may have.

Furthermore, nutrition plays a vital role in recovery. A balanced diet rich in vitamins and minerals, particularly B vitamins, can support nerve health and healing. Staying hydrated and avoiding smoking and excessive alcohol can also promote better recovery outcomes.

In summary, while your experience may feel concerning, it is crucial to maintain open communication with your healthcare providers. They can guide you through the recovery process, ensuring that you receive the appropriate care and rehabilitation necessary for optimal recovery. Remember, recovery from nerve and tendon injuries can take time, and patience is key.

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