Complex Nerve Injuries of the Shoulder, Arm, Elbow, Forearm, Wrist & Hand
Get answers—and a plan to regain function
Complex nerve injuries in the upper extremity can cause weakness, loss of sensation, pain, or loss of fine motor control. These injuries may follow trauma, lacerations, fractures, crush injuries, dislocations, iatrogenic injury, or severe compression/entrapment. Early evaluation by an upper-extremity nerve specialist can protect muscle, shorten recovery time, and improve outcomes.
What Counts as a “Complex” Nerve Injury?
“Complex” means more than a routine pinched nerve. It often involves multiple nerves, longer gaps, scarring, neuromas, or combined bone/soft-tissue injuries requiring advanced reconstruction such as nerve grafts, nerve transfers, neuroma surgery (e.g., TMR/RPNI), or tendon transfers.
Common patterns
- Brachial plexus injuries – traction/avulsion after MVCs or falls; variable loss of shoulder/elbow/hand function
- Radial nerve – wrist drop, weak finger/thumb extension
- Median nerve – loss of thumb pinch, decreased grip, palm numbness; high median injuries affect pronation and forearm strength
- Ulnar nerve – ring/small finger numbness, intrinsic weakness, clawing, loss of fine motor skills
- Combined injuries/neuromas – severe pain triggered by light touch; functional loss
Signs & Symptoms
- Sensory: numbness, tingling, burning; electric-shock pains; hypersensitivity
- Motor: weakness or paralysis; loss of grip/pinch; muscle atrophy; wrist drop / claw hand / “ape hand” depending on nerve
- Autonomic/skin: temperature or sweating changes, color changes, shiny or thin skin
- Neuroma-related pain: point tenderness with light touch or movement
- Urgent red flags: open wounds with numbness/weakness, profound new weakness after injury or surgery, rapidly worsening pain/swelling. Seek care promptly.
What Causes Complex Nerve Injuries?
- Trauma: lacerations, fractures/dislocations, crush injuries, gunshot wounds
- Stretch/avulsion: especially brachial plexus after high-energy trauma
- Iatrogenic: nerve injury during prior procedures
- Tumors/infection/scar: compression or invasion
- Severe entrapment: chronic compression with significant weakness or atrophy
How We Diagnose
A thorough evaluation aligns your symptoms, exam, and imaging to the exact nerve level and severity.
- Expert examination of motor, sensory, and reflex function
- Imaging as needed: high-resolution ultrasound, MRI, or CT when fractures or masses are suspected
- Electrodiagnostics (EMG/NCS) to localize injury, measure severity, and track reinnervation (often most informative ≥3 weeks after injury)
- Shared plan clarifying the likelihood of spontaneous recovery vs. need for reconstruction
Treatment Options (Personalized to Your Goals)
Conservative care (when appropriate): targeted hand therapy, protective splints, desensitization, neuropathic pain strategies, activity modification, injections for select compressions.
Microsurgical reconstruction (when indicated):
- Primary repair for clean lacerations with minimal gap
- Nerve grafting (autograft/allograft) to bridge larger gaps
- Nerve transfers (e.g., Oberlin transfer for elbow flexion; other targeted transfers for radial/median/ulnar recovery) to re-route healthy donor nerves for faster reinnervation
- Neuroma surgery including TMR (targeted muscle reinnervation) or RPNI to reduce pain and improve prosthetic control when relevant
- Tendon transfers to restore key motions when motor nerves are irrecoverable or recovery would be too slow for the target muscle
- Rehabilitation & follow-up: custom therapy protocols, neuromuscular re-education, strengthening, and serial assessments to track return of sensation and strength.
- Typical nerve regrowth rate: approximately 1 mm/day from the site of repair/transfer to the target muscle or skin—timelines vary by age, health, and distance.
- Emerging/regenerative options: biologic adjuncts (e.g., PRP/PRF) may be considered as part of a comprehensive plan; evidence and candidacy are discussed case-by-case.
Why Choose Our Nerve Clinic
- Upper-extremity fellowship training with high-volume nerve reconstruction
- Operative microscope and microsurgical techniques used routinely
- Advanced diagnostics (ultrasound-guided exams, precise EMG/NCS interpretation)
- Integrated hand therapy focused on nerve-specific recovery
- Second opinions welcomed; we collaborate with your existing team
- Insurance-friendly: Medicaid and most major plans; we’ll help verify benefits
What to Bring (or Upload Securely)
- Actual image files (X-ray/MRI/CT) + reports
- Prior op notes, EMG/NCS, clinic notes
- Medication list & relevant medical history
- A short list of personal goals (e.g., “return to OR,” “play tennis,” “lift 30 lbs”)
FAQs
Is it ever “too late” to fix a nerve?
Not always. Options may shift from nerve repair/graft toward nerve or tendon transfers as time passes. An exam clarifies what’s still recoverable.
What’s the difference between a nerve transfer and a tendon transfer?
A nerve transfer re-routes a working nerve to power a denervated muscle (potential for more natural control if timing is right). A tendon transfer repositions a working tendon to replace lost motion and can be effective when nerve recovery is unlikely or too slow.
How long will recovery take?
It depends on injury level and distance to the target. Nerves typically regrow about 1 mm/day; functional return can take months and continues to improve for 12–24 months.
Do I need EMG/NCS before I come in?
Helpful but not mandatory. If needed, we’ll time the study for maximum accuracy and value.
Can you help with neuroma pain?
Yes. Options include desensitization, targeted injections, and surgical treatments like TMR/RPNI for select cases.
