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What can help nerve injury near the elbow?

Q: My father and I were out hunting and there was an accident that was my fault. Dad ended up with a nerve injury near his elbow. His hand still doesn't work very well. I'm searching on the internet for any information I can find that might help him and I found your site. Can you help me?

A: There are three major nerves around the elbow that can be affected by an injury such as you mention. These three nerves (radial, ulnar, median) can be cut, pinched, crushed, or stretched in ways that leave the hand paralyzed or sometimes less than functional.

Treatment often begins with hand therapy to improve motion, strength, and function. The hand surgeon uses this time to evaluate how quickly the nerves are healing and whether or not to do surgery. Knowing when to repair the problem versus reconstruct the damaged anatomy is a challenge for the hand surgeon. Use of nerve or tendon transfers early is advised with there are signs that motor function won't occur, rehab will be lengthy, or recovery just isn't possible.

It's likely that your father has had many tests done to determine the extent of injury and help plan treatment. All muscles (and their attached tendons) are tested for loss of function against gravity and against resistance. Grip and pinch strength are measured. Special tests for sensation are carried out.

Surgery isn't always needed for nerve injuries. Some patients recover completely with time and hand therapy. But if several months go by with no improvement or only minimal recovery, then it's time for the hand surgeon to take a second look.

Special neurodiagnostic tests can be ordered to see if and how much the nerves are firing. The results of these tests along with clinical observations is often enough to suggest the need for surgery to repair or reconstruct the damaged area.

Time is still an important factor in recovery. Nerves recover very slowly at a rate of about one inch each month. After 18 months without nerve stimulation, the motor endplate (junction where the nerve connects to relay messages) starts to degenerate. If the nerve gets there too late, the patient won't regain motor control. In other words, the muscle doesn't get the message to contract and use of the hand is limited.

In cases where it looks like recovery will be delayed too long, the surgeon has the opportunity to perform a tendon or nerve transfer. This means a piece of tendon or nerve from another area of the elbow or forearm is used to replace the damaged structures. Often there are extra branches or even duplicate fibers that can be used without damaging the donor tissue.

If your father is approachable, you may want to let him know of your interest and concern. He may be open to your questions about what the doctor has said and what is his prognosis (what will happen, how much recovery he will get). He may be able to explain the plan for treatment down the road as well.

If you don't feel comfortable asking these questions directly, perhaps there is some other adult family member (your mother, an uncle) or close friend of your father's who could explain what's going on and answer your questions. If none of that is possible, then just wait and watch carefully what happens over time as recovery and healing take place. With nerve injuries, it is a long, slow process that can take months up to two years or more.

Reference: Andrew R. Tyser, and Kenneth R. Means, Jr, MD. Nerve Injuries About the Elbow: Treatment Options. In Current Orthopaedic Practice. January/February 2012. Vol. 23. No. 1. Pp. 29-33.

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