Nerve Repair After Thumb Injury: Key Concerns and Recovery

Injury to the digital nerve of the index finger in the thenar region of the palm?

Hello Doctor,
On January 19, I accidentally cut my thumb while slicing fruit, resulting in a wound approximately 10 cm long, and I was urgently taken to the hospital for surgery.
My first follow-up appointment after discharge was on January 31, where the doctor informed me that two nerves in my index finger were severed and successfully reconnected during surgery.
Other nerves and tendons were unaffected.
The doctor mentioned that although the nerves have been reattached, they grow very slowly, and it will take at least four weeks to determine if the surgery was successful.
I was scheduled for a follow-up appointment at the end of March, but no further information was provided.
I have a few questions:
1.
Is the end of March follow-up appointment too far away? (I found information stating that rehabilitation can begin after six weeks, and the doctor also mentioned that the nerve growth status can be assessed after four weeks.
However, it seems that the schedule might be full, which is why my appointment is set for the end of March.
If it’s too long, I would like to reschedule for an earlier appointment.)
2.
Currently, my hand (from fingers to arm) is immobilized in a cast.
During this period, should I perform any bending or other movements with my fingers and arm to prevent muscle atrophy?
3.
In the past couple of days, each finger on my injured hand has suddenly become dry and started to peel.
Although it is not painful, is this a normal phenomenon? Is there any way to improve this condition?
4.
My index finger has a tingling sensation and feels somewhat tight.
I can bend it, but it seems unable to straighten fully.
When I try to straighten it with slight force, I experience a strong pulling sensation.
Is this normal?
5.
If the nerve reconnection fails, what impact will it have on my daily life? Will it affect my grip strength? My job requires extensive use of my thumb, index finger, and middle finger.
Thank you, and I wish you peace and well-being.

tsaofan, 20~29 year old female. Ask Date: 2012/02/02

Dr. Lu Daokuan reply Plastic Surgery

Nerve repair in the fingers does take time, and after the follow-up appointment at the end of March, rehabilitation should be actively pursued.
Whether the cast needs to be fixed for six weeks should be determined by the attending physician.
You can discuss the rehabilitation schedule with your attending physician.
The recovery process may involve numbness and stiffness, which are part of the healing process.
For dry skin, you can apply lotion.

Reply Date: 2012/02/02

More Info

In response to your inquiry regarding nerve repair after a thumb injury, it's essential to understand the complexities involved in nerve recovery and rehabilitation. Nerve injuries, particularly those involving the digital nerves of the hand, can significantly impact functionality, and the recovery process can vary widely based on the extent of the injury and the type of surgical intervention performed.

1. Timing of Follow-Up Appointments: You mentioned that your follow-up appointment is scheduled for the end of March, which is approximately six weeks post-surgery. While it is true that some sources suggest that nerve regeneration can be assessed around six weeks after surgery, it is also crucial to consider that nerve healing is a slow process. Nerves typically regenerate at a rate of about 1 millimeter per day, which means that for a 10 cm injury, it could take several months to fully assess the recovery. If you feel that waiting until the end of March is too long, especially if you are experiencing concerning symptoms, it would be reasonable to contact your healthcare provider to discuss the possibility of an earlier appointment or to seek a second opinion.

2. Maintaining Muscle Function: During the immobilization period with a cast, it is generally advised to perform gentle range-of-motion exercises for the unaffected joints to maintain flexibility and prevent stiffness. However, you should avoid any movements that could stress the injured area or disrupt the surgical repair. Once your doctor gives you the green light, you can start rehabilitation exercises specifically designed to promote nerve recovery and muscle strength.

3. Skin Changes: The dryness and peeling of the skin on your fingers can be a common occurrence, especially when a limb is immobilized. This can be due to reduced circulation and lack of movement. To improve this condition, you can apply a gentle moisturizer to the affected areas, ensuring that it does not interfere with the surgical site. If the dryness persists or worsens, consult your healthcare provider for further advice.

4. Sensory Changes: The tingling sensation and tightness you are experiencing in your index finger can be attributed to nerve regeneration. As the nerve heals, it may cause abnormal sensations, which can be uncomfortable. The inability to fully extend your finger and the sensation of tightness may also indicate that the surrounding tissues are still healing. It is essential to follow your doctor's advice regarding rehabilitation exercises to promote recovery and regain full function.

5. Impact of Nerve Repair Failure: If the nerve repair does not succeed, it can lead to significant functional impairments. You may experience weakness, loss of sensation, or difficulty performing tasks that require fine motor skills, particularly those involving the thumb, index, and middle fingers. This could affect your ability to perform daily activities and impact your work, especially if it requires dexterity. If nerve regeneration does not occur adequately, options such as occupational therapy, splinting, or even surgical interventions may be explored to improve function.

In summary, nerve repair is a complex process that requires patience and adherence to medical advice. Regular follow-ups with your healthcare provider are crucial to monitor your progress and make necessary adjustments to your rehabilitation plan. If you have any concerns about your recovery or the symptoms you are experiencing, do not hesitate to reach out to your medical team for guidance. Your proactive approach to managing your recovery will be beneficial in achieving the best possible outcome.

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