Specialized Hand & Wrist Care in Colorado Springs

Complex Nerve Injuries of the Upper Extremities

Colorado Springs Orthopaedic Group

Your hands and wrists play an important role in nearly everything you do, from working and exercising to performing everyday activities. Injuries, arthritis, nerve conditions, tendon problems, and other disorders can cause pain, weakness, stiffness, or loss of function.

CSOG provides comprehensive care for conditions affecting the hand, wrist, fingers, and surrounding structures. Our specialists offer a range of nonsurgical and surgical treatments, including therapy, injections, minimally invasive procedures, and advanced surgical techniques when appropriate.

Whether you are dealing with a new injury or a condition that has gradually affected your function, our team will evaluate your individual needs and develop a treatment plan focused on relieving symptoms, restoring function, and helping you return to the activities you enjoy.

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What are Complex Nerve Injuries of the Upper Extremities?

Complex nerve injuries of the upper extremities refer to damage to one or more nerves in the shoulder, arm, forearm, or hand, leading to significant functional impairment, pain, and sensory loss. These injuries can be caused by trauma, compression, lacerations, or nerve entrapment syndromes and may require advanced surgical interventions, including nerve grafting, nerve transfers, and tendon transfers.

Types of Complex Nerve Injuries of the Upper Extremities

• Brachial Plexus Injuries: Damage to the network of nerves that control the arm and hand.
• Radial Nerve Injuries: This can result in wrist drop and difficulty extending the fingers.
• Median Nerve Injuries: Affect thumb function and sensation in the palm (e.g., high median nerve injuries affecting pronation and grip strength).
• Ulnar Nerve Injuries: Lead to claw hand deformity and loss of fine motor skills in the fingers.

Causes of Complex Nerve Injuries of the Upper Extremities

Common causes of complex nerve injuries of the upper extremities include:

• Trauma: Lacerations, fractures, gunshot wounds, or crush injuries.
• Stretch or Avulsion Injuries: Brachial plexus injuries from motor vehicle accidents or falls.
• Iatrogenic Injuries: Nerve damage during surgical procedures.
• Tumors or Infections: Nerve compression or invasion by tumors or infections.
• Repetitive Use or Chronic Conditions: Severe cases of entrapment neuropathies.

Signs and Symptoms of Complex Nerve Injuries of the Upper Extremities

The signs and symptoms of complex nerve injuries of the upper extremities depend on the severity and location of the nerve damage. These injuries can affect sensory, motor, and autonomic functions, leading to significant disability.

Sensory Impairments:

• Numbness, tingling, or loss of sensation
• Hypersensitivity or burning pain
• Electric shock-like pain
• Burning or stabbing pain

Motor Deficits:

• Muscle weakness or paralysis
• Loss of grip strength and fine motor control
• Muscle atrophy over time
• Claw hand (ulnar nerve), wrist drop (radial nerve), or ape hand (median nerve)

Reflex Changes:

• Reduced or absent deep tendon reflexes

Autonomic Dysfunction:

• Abnormal sweating, skin changes, and temperature regulation issues

Neuroma-Related Pain:

• Localised severe pain, triggered by light touch or movement

Diagnosis of Complex Nerve Injuries of the Upper Extremities

The diagnosis of complex nerve injuries of the upper extremities involves a combination of clinical evaluation, electrodiagnostic studies, and imaging techniques. A thorough physical examination assesses muscle strength, sensory function, and reflexes to determine the extent and location of nerve damage. Electrodiagnostic tests, including electromyography (EMG) and nerve conduction studies (NCS), help evaluate nerve function, identify conduction blocks, and differentiate between nerve compression and more severe injuries like nerve transection. Imaging modalities such as MRI or high-resolution ultrasound can provide detailed views of nerve continuity, scarring, or compression by surrounding structures. In cases of traumatic injury, additional imaging like CT scans may be used to assess fractures that may contribute to nerve damage. A comprehensive diagnostic approach helps guide treatment planning, whether surgical or conservative.

Treatment for Complex Nerve Injuries of the Upper Extremities

Treatment for complex nerve injuries of the upper extremities depends on the severity and type of injury. Conservative management, including physical therapy, splinting, and pain management, may be sufficient for mild injuries or cases with partial nerve function. However, severe injuries often require surgical intervention. Direct nerve repair is performed when the nerve ends can be sutured together, while nerve grafting using a donor nerve, such as the sural nerve, is necessary for bridging larger gaps. In cases where nerve regeneration is unlikely, nerve transfers can be used to reroute a functional nerve to restore movement, such as the Oberlin transfer for biceps reinnervation. Tendon transfers may also be employed to compensate for lost motor function. Emerging treatments, including regenerative therapies like platelet-rich plasma (PRP) and special cell therapy, are being explored to enhance nerve healing. Rehabilitation through physical therapy and neuromuscular re-education plays a crucial role in optimizing functional recovery.