Tendon, Artery, and Nerve Damage

Introduction

Hand injuries involving tendons, arteries, and nerves are complex and often interrelated. This comprehensive guide provides insights into these types of injuries, their causes, symptoms, diagnostic procedures, treatments, and potential complications.

Understanding Tendons

Tendons are cord-like structures that run from the forearm, through the wrist and hand, and into the fingers. They play a crucial role in enabling finger and thumb movements for gripping, making fists, and opening hands.

Types of Tendons in the Hand

On the other hand, there are two main types of tendons:

Flexor Tendons: These tendons, located on the palm side, facilitate finger bending, allowing us to grip objects.

Extensor Tendons: Situated on the back of the hand and forearm, extensor tendons enable finger and wrist extension for hand opening.

Common Tendon Injuries

Tendon injuries typically result from cuts or sudden, forceful pulls against the tendon. Flexor tendon injuries commonly occur when there is a cut on the palm side of the hand, while extensor tendon injuries are associated with cuts on the back of the hand and forearm.

Causes and Symptoms

Injuries to hand tendons often result from accidents, such as workplace incidents, road traffic accidents, glass cuts, or household mishaps. Symptoms include an inability to move the affected finger, loss of bending or straightening capability, and pain during movement. Tendon injuries can be accompanied by bone injuries.

Management of Tendon Injuries

The management of tendon injuries involves:

• X-rays: To rule out associated bone injuries.
• Neurovascular Examination: To assess the overall hand health.
• Surgery: Primary repair within 7-10 days of injury for optimal results.
• Splinting: Immobilization for 4-6 weeks.
• Physiotherapy: Vital for preventing tendon adhesions, re-rupture, and joint contracture.

Blood Supply to the Hand

The hand receives dual blood supply from the radial and ulnar arteries. Fingers also have dual blood supply on either side.

Causes of Arterial Injury

Arterial or venous injuries may occur due to sharp cuts, avulsion injuries, or crush injuries.

Presentation and Emergency Treatment

Arterial injuries present as emergencies with active bleeding. Immediate control through pressure and limb elevation is critical. Veins can often be safely ligated, but arteries should preferably be repaired to restore blood flow.

Bilateral Arterial Injury

If both the major arteries (radial and ulnar) of the hand or finger are cut, then the hand is devoid of blood supply completely. The patient will have a white cold hand without any sensation or movement.

Immediate and emergency surgery should be done within 6 hours of the injury and both the arteries should be anastomosed microsurgically. This procedure is called a revascularization procedure which is totally different from reimplantation of cut body parts after amputation.

If a major artery is ligated inadvertently by anyone or a Primary Health caregiver, then arterial repair should be done by an experienced hand surgeon as early as possible with or without the help of a vein graft.

Treatment at Kayakriti

• The patient is admitted on an emergency basis and OT is arranged
• The patient is operated in a brachial block or general anesthesia
• Repair of the artery is done using 10-0 suture under microscope magnification.
• Postoperatively, the area is immobilized with splints. Hourly monitoring is required for the first 24 hours.
• Heparin infusion for 3 days is given to prevent clotting of blood at the site of anastomosis.
• Aspirin + Clopidogrel is continued for 4 weeks for the same reason.
• The patient is admitted for about 4-5 days after the surgery

Complications

Complications may include arterial spasm, blood clot formation, or rupture at the repair site if infection occurs.

Overview of Nerve Injuries

Injuries can affect the median, ulnar, and radial nerves at various levels in the arm, forearm, and hand. Each nerve has specific functions and areas of distribution.

Importance of Nerve Repair

Untreated nerve injuries can lead to weakness, deformity, muscle wasting, and sensory loss, which may result in unnoticed burns on the fingertips.

General Management

• Diagnosis is often clinical but may be supplemented by nerve conduction velocity (NCV) tests.
• Primary nerve repair is the preferred treatment, ideally performed as soon as possible.
• Late presentations with deformities or muscle wasting may require nerve or tendon transfers.
• Immobilization of the hand helps protect repaired nerves.

Conclusion

Hand injuries involving tendons, arteries, and nerves demand prompt and expert care of an experienced surgeon like Dr. Amit. Timely diagnosis and intervention are essential to prevent complications and restore hand function. These injuries, though complex, can often be successfully managed with surgical techniques and post-operative rehabilitation.