PERIPHERAL NERVES
Compression neuropathies are not uncommon in the hand. The commonest is the carpal tunnel syndrome. There are many predisposing factors for the nerve compression. The treatment is invariably managed by decompressing the nerve in the tunnel of the wrist. Other nerves that can be affected in isolation or concurrently are the ulna nerve, radial nerve, and digital nerves. Nerve compression may also occur at multiple anatomical sites along the same nerve. This is known as the double crush syndrome. The patient is usually subjected to investigations by nerve conduction test and muscle electromyography to assist in the diagnosis.
Nerve injury from trauma is also not uncommon. The mechanism of the injury can be as result of penetrating injury like a stab or gunshot, blunt injury or traction injury. Steps of management depending on the nature and the onset of the injury; may include a period of observation, exploration, release of the nerve and repair of nerve. Any nerve with a motor function of stimulating muscles in the body needs to be attended to as soon as possible in order to prevent the possibility of irreversible muscle inactivity. As a rule of thumb the muscle activity has to be restored within a period of 18 months from the time of injury. A rehabilitation program is also essential to retrain the hand and prevent abnormal positioning of the hand. In the event that the nerves are not repairable the salvage operations to improve the function of the hand is by nerve transfers or tendon transfers. Nerve injury can also result in severe pain which can be distant from the site of injury. It is very important to manage this pain appropriately and prevent it developing into a chronic pain syndrome which is recalcitrant to treatment.