nerve damage after hand injury: learn the signs

nerve damage after hand injury: learn the signs

Hands are the most common site of a nerve injury. From everyday hazards like slicing into your hand with a kitchen knife, to more traumatic accidents like a run-in with a power tool or even a surgical injury, a hand injury can lead to chronic pain, numbness and more.

If you previously went to the ER for a hand injury, you may have a nerve injury without knowing it. As many as 91% of nerve injuries are missed in the ER, and these injuries may lead to chronic pain even after the original wound has healed.

which nerves are part of the hand?

There are three main nerves in the hand. All three branch out from the brachial plexus, the network of nerves that connects your spine to your shoulders, arms and hands. These nerves allow you to both move and touch with your hands.

  • Median nerve: The nerve that runs from the shoulder down the front of the forearm to the hands.
  • Ulnar nerve: The nerve that begins at the armpit and runs to the hand, responsible for controlling the small muscles of the hand.
  • Radial nerve: The nerve that starts at the lower armpit, passing through the channel of bone and muscle at the elbow and extending to the wrist and hand. This nerve helps control the wrists, hands and fingers.

5 common causes of nerve damage from hand injuries

  1. The most common cause of nerve damage involves cuts or lacerations to the nerve. This can happen while cutting into an avocado or bagel, slicing your hands on broken glass, or from broken bones, gunshot wounds or accidents involving power tools.
  2. A previous hand surgery may also lead to chronic pain. A surgeon may have cut or otherwise injured a nerve, causing numbness, weakness, pain (tingling or burning) or other physical changes. If your symptoms remain past the expected recovery time, you may have a surgically induced nerve injury. Read how one patient, Benjamin, found healing after an arm surgery resulted in chronic pain.
  3. Even a cut or wound that seems minor at first may lead to impaired hand function later. When nerves aren’t properly repaired after a surgical accident or other injury, they may form a neuroma, or a tangle of nerve tissue that can cause chronic pain.
  4. Another common cause of nerve damage is compression. When too much pressure is placed on the nerve, it can become inflamed. A common example is carpal tunnel syndrome, which can occur from repeated grasping motions, such as at a computer desk or bicycle handlebars. Broken or fractured bones can also cause nerve compression injuries.
  5. Stretching is another cause of nerve damage. This happens when the body moves suddenly in a way it doesn’t normally move, such as during a car accident or sports injury. In severe cases, injury to the brachial plexus—the network of nerves that connect your spinal cord to your shoulder, arm and hand—can lead to muscle weakness and pain in your hand. ­­

symptoms of nerve injury to the hand

Common symptoms of a nerve injury to the hand include:

  • Pain in the hand—which can be excruciating, shooting pain that may feel like an electric shock
  • Tingling, numbness or altered sensation
  • Weakness or loss of motor function
  • Loss of sensation, including either a full or partial loss of feeling
  • Sensitivity to cold or heat
  • Loss or decrease in hand function/fine motor skills, such as an inability to grasp things, frequently dropping things, difficulty tying your shoe or buttoning your shirt, etc.
  • Inability to move the hand or wrist
  • Decreased muscle tone in the hand

what can I do about nerve damage?

An orthopedic hand surgeon or plastic reconstructive surgeon may be able to help repair peripheral nerves by reconstructing the nerve (in the case of a cut) or freeing the nerve from the pressure of the surrounding tissue (in the case of compression injuries). The good news is that studies show positive improvements in quality of life for people who undergo surgery to repair a damaged nerve.

Timing is important when it comes to nerve repair. If you’re experiencing pain and/or numbness for more than six weeks after a hand injury or other previous surgery, you may have a nerve injury. The sooner you seek treatment, the more sensory and motor function you are likely to recover.

If you’re ready to talk to a doctor about treating your chronic nerve pain, we’ve created a guide to help you locate someone.

how can surgery result in nerve damage?

Nerves are like the electrical wires of the body, carrying signals to and from your brain. They allow you to move, feel and touch—but when one is cut or damaged, those signals are interrupted. This can cause pain, numbness, burning or loss of function in the affected body part.

nerve damage after surgery

Chronic post-operative pain is common. If you have pain after surgery that lingers beyond the normal recovery time, you may have a damaged nerve. Significant numbers (10%–40%) of patients experience chronic neuropathic pain after surgery. This is known as surgically induced neuropathic pain (SNPP).

Common signs of nerve damage include:

  • Pain (especially tingling or burning sensations or sharp shooting pain)
  • Numbness
  • Pressure or squeezing sensation
  • Weakness
  • Hypersensitivity
  • Physical changes (such as changes to muscle mass, skin color)
  • Decreased motor function

Nerves can be challenging to see during surgery. Their size, anatomy and location can vary from person to person. Sometimes, a surgeon may unintentionally cut, compress or stretch a nerve. This damages the nerve and can lead to chronic pain.

what kinds of surgery can result in nerve damage?

Any surgery, routine or otherwise, can result in nerve damage, but it occurs most often in these types of procedures:

  • Joint replacements such as hip or knee replacements
  • Thoracotomy: a surgery where the surgeon cuts between the ribs to reach organs in the chest cavity (lungs, for example)
  • Hernia repair: a procedure to contain the bulge of a hernia inside the body
  • Caesarean section: also known as a C-section, this surgery ensures delivery of a baby through an incision in the birth mother’s abdomen
  • Abdominoplasty: a cosmetic surgery to make the abdomen appear thinner and more firm, also known as a “tummy tuck”
  • Hysterectomy: the surgical removal of the uterus
  • Open reductions and internal fixation (ORIF): a surgery to repair broken bones that requires hardware to ensure the fractured pieces remain connected
  • Nerve biopsy: a procedure to remove part of a nerve for sampling in a lab
  • Amputation: loss or removal of a body part, such as a hand, leg, etc.
  • Mastectomy: a surgical operation to remove one or both breasts
  • Laparoscopic or arthroscopic procedures: also known as keyhole surgery, an operation that allows a surgeon to operate by inserting a camera into the abdomen, pelvis or knee through small incisions

what can i do about nerve damage after surgery?

A peripheral nerve surgeon may be able to help. Nerve surgeons specialize in the surgical repair of peripheral nerves, including nerve damage that may have occurred during a previous surgery. These include plastic reconstructive surgeons, orthopedic hand surgeons, neurosurgeons, oral maxillofacial (ear, nose and throat) surgeons, and foot and ankle surgeons (doctors of podiatric medicine). Learn more about the types of nerve surgeons and what they do.

If you’re ready to talk to a doctor about treating your chronic nerve pain, we’ve created a guide to help you locate someone.

how to talk to your doctor about pain

“What brings you in today?”

The pause before answering that question is not uncommon, and it’s rarely easy to answer.

How do we talk when we talk about pain? And how do we talk to others about our pain? More so—how do we talk to our doctors about pain? Making sure that our doctors take our pain seriously is critical as we look to them for guidance on how to improve our pain or eliminate its source.

Is there specific pain terminology we should be using? A secret language about pain that makes it easier to relate? Or are our senses and memories easier to reference when trying to convey the distinct and direct pangs experienced during bouts of chronic pain?

These are the questions that keep us up at night.

Thankfully, there are many pain assessment tools that exist to help patients and doctors talk about experiencing and managing pain. Understanding the common phrases and practices used to quantify and qualify pain will make sure you’re prepared to talk about it when appointment time comes.

the pain scale

Pain is inherently subjective, so finding a common ground for discussing its impact is crucial. There are several different pain scales that your doctor may use. The Numeric Rating Scale (NRS-11) was invented by Dr. Ronald Melzack and Dr. Warren Torgerson of McGill University. Derived from the McGill Pain Questionnaire, the NRS-11 is an 11-point scale for patient self-reporting of pain. These 11 points on a spectrum range from zero to 10, with zero denoting no pain and 10 denoting the worst pain imaginable. All points are based on the ability for persons 10 years or older to perform daily activities.

This scale lets doctors and patients speak about pain in a common, simplified language. “On a scale of one to 10, how much does it hurt?” This question becomes much easier to answer and creates a solid starting point for continued conversation about managing and alleviating pain.

 

For children, there’s the addition of the Wong-Baker FACES® Pain Rating Scale, which adds a visual element to the pain scale and allows children to align their feelings to an expressive face.

Of course, qualifying that pain becomes even more important once you’ve established its quantitative level.

common pain terminology

Is it a sharp pain or a dull pain? Is it burning or tingling? After establishing the level of pain, being able to articulate the kind of pain may help narrow down treatment options or solutions.

Here’s a list of common terms used when talking about pain:

  • aching
  • biting
  • burning
  • cramping
  • draining
  • dull
  • exhausting
  • gnawing
  • heavy
  • hot
  • piercing
  • pinching

 

  • pressure
  • sharp
  • shooting
  • sickening
  • sore
  • splitting
  • stabbing
  • tender
  • throbbing
  • tingling
  • tiring
  • twisting

 

With the above words as tools you can more easily describe your situation. For example, “It feels sharp and stabbing. It’s like a lightning bolt that pierces quickly without warning.” Or even, “My arm is constantly aching and tender to the touch. It feels like pins and needles that don’t quit.”

Sentences like these provide more context as to the duration of the pain, the sensation and the degree to which the feeling persists. When describing how you feel, make sure you’re also able to communicate:

  • How long you’ve had the pain
  • Where the pain is located
  • When the pain is present—is it constant, or does it come and go?
  • What activities aggravate the pain, trigger the pain, or soothe the pain

medical pain terminology

To get even more detailed, you can move beyond the common terms and use more clinical pain terms. Combining a common language of pain with medical terminology will set you up for a successful conversation during appointments. For example, there is more than one type of pain, medically speaking:

  • Acute: a sudden onset of pain that usually lasts for a short period of time
  • Chronic: a condition that lasts for a long time, it can be constant or intermittent
  • Visceral: pain related to the internal organs in the midline of the body
  • Somatic: pain that occurs in tissues such as the muscles, skin or joints
  • Myofascial: pain and soreness in the muscles
  • Breakthrough: pain that occurs suddenly or as a result of a specific activity
  • Inflammation: a reaction of tissues to injury or disease; commonly manifests as swelling, redness, heat and pain

There are plenty of other terms used in the universe of pain management. Many are documented in pain management glossaries and online reference materials.

advocating for yourself

Armed with the right tools to talk about pain, you’ll be better equipped to communicate what you are feeling and how it impacts your day-to-day life. Bring in notes and write out any questions you may have ahead of time so you’re ready to ask, listen, and make a plan to move forward toward a pain-free solution.

navigating nerve pain

When you’re ready to talk to a doctor about pain, we may be able to help. If your chronic pain started after a traumatic injury, surgery, or amputation, it could be the result of nerve damage. Take the quiz to see if you’re a potential candidate for surgical nerve repair.

understanding common causes of nerve damage

Nerves can be injured in more ways than you might think. From kitchen accidents, car wrecks, sports injuries to injury during surgery, there are several situations that can lead to damaged or injured nerves. But there are four common types of nerve injury that can sometimes lead to chronic pain:

  • Cut or laceration
  • Stretching
  • Compression
  • Neuroma

four common causes of nerve damage

When it comes to nerve damage, what causes nerve pain? And why? Let’s break down what each of these causes of nerve damage are, what they mean and how they commonly occur.

cut or laceration

The most common cause of nerve damage involves cuts or lacerations to the nerve. These injuries can occur due to a traumatic event or even during a surgery.

Individuals can sustain this type of injury if they have experienced a severe cut. For example, slicing into your hand while cutting an avocado or bagel or falling through glass. Nerves can accidentally be cut during surgery or may even need to be cut in a procedure like a mastectomy or tumor removal, where cutting the nerve may have been unavoidable. Nerves can also be cut by a broken bone.

stretching

Much like a rubber band, nerves have a tipping point when stretched too far. When that point is reached or exceeded, injury to the nerve can occur. Stretching can cause damage to the internal structure of the nerve, and the nerve may no longer function properly.

Nerves can be stretched too far during retraction of tissues during surgery, or, for example, during the placement or removal of orthopedic implants. In fact, 10%–40% of patients experience chronic neuropathic pain after surgery.

Nerves can also be stretched during an injury when sudden, sometimes violent, movement jostles the body in a direction it wasn’t made to move. When this fast, unnatural movement occurs, the stretched nerve fibers can be stressed to the point of injury.

A movement like this can occur in sports injuries, car accidents or even during childbirth. Depending on the extent of the injury, a stretched nerve injury may be temporary or permanent. If the damage to the nerve fibers is severe enough and the nerve is not fixed, the growing nerve fibers may form a painful neuroma which can be the cause of chronic pain.

compression

We all know what it’s like to be under a lot of pressure. When that pressure gets to be too much, we burn out, snap or give in. When nerves experience exceeding amounts of pressure, they also begin to perform at less than their best.

Nerve compression occurs when nerves are squeezed, pinched or otherwise pressured by surrounding tissues. This extra strain disrupts normal nerve function, which can lead to muscle weakness, numbness, burning or tingling, or immense pain.

Compression injuries often occur near joints like elbows, wrists and ankles—any place where surrounding bones, ligaments, tendons and muscles have an opportunity to add undue stress to the nerve. They can also be the result of a previous surgical or traumatic injury where scar tissue has developed and is compressing the nerve. When a nerve is compressed, it can become inflamed, which can lead to nerve pain.

neuroma

A neuroma is a tangled mass of nerve and scar tissue that may form when nerve damage, either from an injury or during a surgical procedure, goes unrecognized or isn’t properly repaired. Unrecognized nerve injuries are a common problem as often times nerve injuries are missed in the ER. When nerve fibers continue to grow without any structure to guide them, normal nerve function is disrupted and can lead to chronic pain.

Symptoms may include pain, loss of function, extreme sensitivity to touch or temperature, or in some cases numbness.

nerve damage and nerve pain

Any one of these common causes of nerve damage can lead to chronic nerve pain. When nerve damage causes nerve pain, it’s important to understand your options for repairing the source of the pain rather than typical treatments which may only temporarily manage the symptom.

Nerve repair is possible. Depending on your nerve injury, there are a number of surgical options available.

how to care for someone living with chronic pain

Chronic pain impacts more than just those who experience it firsthand. Taking care of those who experience pain day in and day out is as taxing as it can be rewarding. Living with someone with chronic pain brings new challenges into a household dynamic that can be difficult to navigate.

6 ways to care for someone living with chronic pain

Here are some tips on caring for someone with chronic pain—and caring for yourself along the way.

1. believe them

An important thing you can do for someone living with chronic pain is believe them when they say their pain is real. Chronic pain is an invisible ailment that can be hard to identify in others.

Asking about their pain and working to grasp its impact could help you better relate to what they are going through. We may never know just what chronic pain does to a person—as each experience is unique—but putting in the effort to empathize rather than sympathize could make a difference.

Once you establish that trust, it may be easier for the person in pain to accept your help and support as they navigate through their journey to relief. Advocating for someone with chronic pain is easier when it stems from a place of respect and understanding.

2. address their physical needs

When living with chronic pain, even the smallest tasks can be daunting. It’s important to make sure that the physical spaces where your loved one spends their time are catered to their needs and habits.

Make sure essentials are within reach and at a level where they can be easily accessed. Toiletries, groceries and medications should be stored where no one has to reach too high or bend too low if mobility is a challenge. Come up with a plan for easy organization so that it’s fast for you to find what they need when you’re around, and simple for them to do the same when you’re unavailable.

Often, chronic pain leads to lots of downtime spent in bed. Bedside organizers are helpful for making sure that all needed items are within reach when a person is sequestered to their bedroom. Books, remotes, medication, tissues, eye masks and more can all be kept close to eliminate the need to move around and potentially further agitate a body in pain.

3. consider their barriers

After everything is situated properly on the home front, it’s time to tackle other factors in their environment. Do they live close to their doctors, their physical therapists, their pharmacy or grocery store? Are they able to drive or work?

Whether it’s food delivery, meal-prep kits or mail-order medication, figure out a way to ease barriers to getting things done. It may be helpful to identify days that you can run errands for them or help them schedule doctor appointments for days when they need someone to take them to and from hospitals or clinics.

4. advocate for their best interests

Doctor appointments can be overwhelming for anyone, and it’s easy to get wrapped up in the moment. When that happens, a person may forget to ask questions or leave the office feeling like they don’t understand all their options.

When it comes to caring for someone you’re close to, offer to attend their appointments with them. Take notes. Ask questions. Make sure that their pain is taken seriously, and not dismissed.

Partner with your loved one to research potential solutions or identify opportunities to meet with new and emerging care teams.

5. manage financial expectations

Chronic pain may lead to a significant financial burden for those who experience it. As a caretaker, it may be helpful to work with your loved one to comprehend their medical bills if they have questions or see if there is some other way you can support them as they navigate their financial needs.

Insurance can be tricky, especially when lots of specialists are involved. If your loved one needs help, most providers can connect you with financial counselors who specialize in medical expenses.

Try to plan ahead so nothing takes you by surprise.

6. focus on emotional needs

It’s good for both you and the person you care for to maintain connection with the outside world. Those living with chronic pain may have a desire to hide away from friends and loved ones in an effort to not let their pain impact the lives of others. There is a strong correlation between chronic pain and mental health disorders. Help them to see how important they are to you—and how important it is to maintain a positive outlook while facing troubles caused by poor physical health.

Continue to invite them to things, continue to include them. Small gestures like an invitation are a great way to let them know they are cared for.

Try not to lose sight of yourself as a person outside of the caregiver role. Make sure that you are taking time for yourself to do the things that bring you joy. You’re best suited to help others when you help yourself first.

chronic pain isn’t one size fits all

Sometimes, chronic pain is caused by nerve damage. This type of chronic pain may be repairable. To learn more about nerve pain, check out our nerve pain 101 page.

Could your loved one’s chronic pain be the result of nerve damage? Take the quiz with them to see if they’re a potential candidate for nerve repair.

Take the quiz

 

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who are peripheral nerve surgeons and what do they do?

Nerve pain is unrelenting and all too often, unbearable. When the time comes to take care of the problem at its source, who do you call?

just who is a nerve surgeon?

Simply put, nerve surgeons specialize in the surgical repair of peripheral nerves, but since nerves run throughout every inch of our bodies, there is not one specific type of surgeon or title that aligns precisely with the specialty of nerve surgery. Instead, there are several types of doctors who specialize in nerve repair. These doctors undergo extensive microsurgical training to become experts in their field.

While injured or damaged nerves can certainly cause a large amount of pain, they are very tiny structures and repairing them can require the use of magnification and specialized knowledge of nerve repair techniques.

The most common physicians who perform nerve surgery are:

  • plastic reconstructive surgeons
  • orthopedic hand surgeons

Additionally, there a select number of other specialists have undergone training for microsurgical nerve repair, such as:

  • neurosurgeons
  • oral maxillofacial surgeons
  • doctors of podiatric medicine (DPMs)

Let’s dive in and learn a little bit more about these specialists, and how each—while not necessarily called a “nerve surgeon”—is qualified to treat nerve damage that may be the cause of chronic pain.

plastic reconstructive surgeons

You may be thinking, “Why would I go to a plastic surgeon for help with nerve pain?”

It’s a common misconception that plastic surgeons only perform cosmetic surgery. In fact, plastic surgery is generally broken down into two areas of concentration: cosmetic and reconstructive.

Cosmetic or aesthetic plastic surgeons often focus on breast augmentation, facelifts, rhinoplasty, etc.

Reconstructive plastic surgeons typically focus on more complex cases that may involve, for example, helping to save a patient’s limb after a traumatic injury or helping to rebuild an area of the face that has been badly damaged.

The word “reconstructive” means “to rebuild after something has been damaged or destroyed,” and these surgeons are trained to reconnect ligaments, muscle tissue and blood vessels to repair damage to a patient’s body. In addition, they often reconstruct and repair nerves.

With extensive microsurgical training, nerve repair is something that reconstructive plastic surgeons perform regularly, especially with patients facing chronic pain caused by a nerve injury.

orthopedic hand surgeons

You may think of an orthopedic surgeon as someone who you see when you break your arm or injure your knee, or when you need a hip replacement. That’s a fair assumption. Orthopedic surgeons specialize in treating your musculoskeletal system—your bones, joints, tendons, muscles and ligaments. They are experts at understanding where and how your body fits together.

And they can also specialize in nerve repair.

As doctors who specialize in muscles and nerves, many orthopedic hand surgeons have made nerve repair a primary focus. But don’t let the term “hand surgeon” fool you. The most common location for a nerve injury is the hand, and these surgeons have received extensive training on the intricacies of nerve repair, not just in the hand, but throughout the rest of the body.

neurosurgeons

While the term “neuro” and “nerve” may seem to go hand in hand, many neurosurgeons are mostly focused on the central nervous system (the brain and spinal cord), rather than the peripheral nervous system (the nerves running all through the body). The function of each is quite different and they serve different purposes.

There are some neurosurgeons who also specialize in working on the peripheral nervous system who are trained to deal with nerves throughout the body.

oral maxillofacial or Ear Nose and Throat (ENT) surgeons

Oral maxillofacial and ENT surgeons focus on the hard and soft tissues in the head, neck, face and jaw. These dental experts can help treat cleft lips, head trauma injuries, and perform reconstructive surgery on head and neck cancer patients.

Some oral maxillofacial and ENT surgeons are also skilled in performing nerve repair on injuries sustained to nerves in the face or jaw. For example, these specialists often work on nerve injuries that can sometimes occur during wisdom tooth extractions or other dental procedures.

foot and ankle surgeons, or doctors of podiatric medicine (DPMs)

It is important to recognize that most DPMs focus only on the tendons, bones and ligaments of the foot and ankle, and do not often specialize in nerve repair.

However, there are a small number of DPMs who have undergone microsurgical training to be able to perform nerve surgery in the feet and lower legs.

is there a qualified nerve specialist near me?

Take our quiz to see if you qualify as a candidate for surgical nerve repair. And then use our Find a Surgeon tool to see who might be a good fit for your needs and where they are located.

Not all plastic surgeons, orthopedic surgeons or neurosurgeons work with peripheral nerves. However, every doctor suggested through our Find a Surgeon tool—whether ortho, plastic or neuro—has taken specific interest in and developed a passion for helping patients with peripheral nerve injuries.

understanding the difference between acute and chronic pain

Much like the people who experience it, pain comes in all shapes and sizes. A sinus headache, a stubbed toe, a scraped knee or a broken arm—pain is a part of everyday life. But sometimes, that pain can transform into something more.

The day-to-day ouches and injuries we battle throughout our lives cause something known as acute pain.

what is acute pain?

Acute pain is the immediate reaction of your body that lets you know “Hey, that didn’t feel good, and you should stop doing whatever that was!” Though it hurts, this pain is a good thing—it lets your body know that a dangerous activity has just occurred, and you should course correct to avoid doing it in the future.

Acute pain doesn’t have a long shelf life. It’s there in the moment and then subsides not long after the initial incident. As soon as you’re healed, the pain goes away.

But what happens when pain lingers?

That’s where chronic pain comes into play. And there is a big difference between acute and chronic pain.

what is chronic pain?

Chronic pain is lasting. It drags on for weeks, months, even years without signs of stopping.

Most of the time when you injure yourself or have a surgical procedure, you feel pain. But after you heal, you feel fine again. Once in a while, that process goes awry. In response to trauma, the body’s nerves may react in a way that can lead to a different, chronic form of pain called neuropathy.

Some studies have found that approximately 30%–77% of individuals have pain six or more months after experiencing trauma.

Neuropathic pain, or nerve pain, has many potential causes and may manifest in a variety of ways. Sometimes it’s caused by the nerve physically being cut, for example, during a traumatic injury or accidentally during a surgical procedure. Neuropathic pain is extremely common among patients who have a cut nerve or had a limb amputated.

However, damage can also result from the nerve being compressed, injured or crushed—even if not actually cut. These types of injuries are most frequently incurred during an accident, a fall, playing sports, or any other activity that can stretch, compress, crush or cut nerves. This includes compression of the nerves due to repetitive stress, for example, carpal tunnel syndrome.

when to seek help

Once you understand the difference between acute pain vs. chronic pain, it will be easier for you to assess next steps. When pain is chronic (lasting more than three months) it’s important to take steps to find its cause and find a solution that lasts.

If you think your chronic pain is the result of a nerve injury, we might be able to help. You may have first experienced nerve pain in the months or years following surgery, trauma or amputation. Like most people, you probably never considered your chronic pain might be the result of nerve damage.

To find out if you’re a candidate for nerve repair, take our quiz.