Everybody today knows of Carpal Tunnel. It has become this mythical scary disease that “afflicts avid typists”. It is a disease that strikes the median nerve in the wrist. But what about the other important nerves? About 1/3 of the patients with hand pain come in worried and thinking they have carpal tunnel syndrome and they need surgery. This is, fortunately, rarely the case.
One such nerve is called Radial. The Radial nerve does two things: 1. Provides sensation to the back of the hand and wrist and 2. Powers multiple muscles, some of which open the fingers and thumb and bring the wrist up.
When a patient looses the ability to open and close the fingers and put the wrist in a usable position, the results are life changing. This devastating injury results in a very inefficient grip. This is because muscles that open the hand counterbalance the muscles required to grip. These muscles require “adjustable” tension in order to function most efficiently. The results of this imbalance are so devastating that all people with this condition cannot grip or pinch anything.
The patient in the photo had a radial nerve injury above his elbow. The effect was life changing. He could not use his hand at all. His fingers and thumb went limp and so did the wrist.
Multiple ways exist to reconstruct nerve injuries. From nerve repairs, to nerve grafting to transferring tendons from other sites to power the deficient ones. These are difficult decisions to make. After a thorough discussion with the patient we decided together to transfer tendons and power the fingers, thumb and wrist. At ROC, Dr. Shuhatovich performs reconstructions for all nerve injuries in the upper extremity.
Now, after the surgery, the hardest part will start. The patient needs to learn to use the new muscles to power the ones that did not work before. Although the road is still long ahead, the patient is very excited. The normal appearance of the position of the wrist and fingers really encourages him to proceed and relearn to use the hand that he could not for two years before. The hardest part now is the connections in the brain that need to be created anew. The patient needs to learn to use muscles designed to power wrist motion to power his fingers. This is no easy task, but generally by 3 months after surgery, patients will have learned to do that very well.