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Irreparable nerve injuries, head
injuries, neck fractures and stroke can
all have serious impact on hand and arm
function. The results are paralysis, loss
of feeling or loss of control.
 Nerve
Injuries
Great technological strides have been
made in repairing cut or crushed nerves in
the hand and arm. Microsurgical methods of
nerve repair are now common-place.
However, there are still occasions when
nerve repair is either not advisable or
not possible. This results in varied
degrees of muscle paralysis and
numbness.
Various reconstructive methods are
available to the hand surgeon to restore
function and feeling. The transfer of one
or more tendons or muscles to replace the
function of paralyzed muscles probably
forms the centerpiece of these
reconstructive methods. In most cases,
such tendon transfers have to be delayed
to allow recovery from initial wounds and
fractures. During this period, a
coordinated effort between the hand
surgeon, the patient, and the hand
therapist is important in preventing
stiffness in the joints which cannot be
spontaneously worked. Similarly, after
surgery the same concentrated effort is
required to re-educate the transferred
muscles in their new function.
Sensory loss in some respects is
similarly addressed by transferring skin
with the attached nerve from other areas
of the hand, arm, or other parts of the
body to the areas of the hand with lost
feeling. This frequently requires
microsurgical methods and a period of
sensory re-education coordinated by the
hand therapist.
Spinal Cord and
Neck Injuries
Injuries to the spinal cord from neck
fractures produce paralysis and numbness
similar to nerve injuries, but is
generally much more extensive. The
treatment principles are similar, but
timing and judgment are more critical.
Stroke and Head
Injury
Some unique problems in rehabilitating
the hand and arm can result from stroke
and head injury. They create not only
paralysis but violent contractures or
spasms of the muscles involved. These
spasms place the joints of the hand,
wrist, elbow and shoulder in extremely
unnatural and non-functional
positions.
Nerve blocks by medication injection
can relieve these violent spasms and allow
therapy to prevent permanent joint
stiffness while initial recovery takes
place.
After the maximal recovery period, the
goals for reconstructive surgery are to
relieve pain, to provide passive mobility
to contracted joints, to facilitate
personal hygiene, or to improve
function.
In the most severely affected limbs,
violently painful spasm and contractures
persist. Simple personal hygiene
requirements such as washing under the arm
or within the palm are impossible. Release
of contracted muscles can relieve pain and
provide access to the palm and
underarm.
The less severely involved arm with
near-normal feeling in the hand will
benefit from procedures to restore
function. This is generally accomplished
by the partial lengthening of residually
tight or spastic muscles, combined with
selective muscle transfers.
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