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手部肌腱与神经损伤

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Hand tendon and nerve injuries – understanding symptoms, diagnosis, and treatment options.

Updated Aug 2026
一幅手绘插图，展示手部肌腱和神经切断后的手术修复。
手掌侧的肌腱和神经位于靠近皮肤的狭窄通道内。切割伤和撕裂伤通常涉及多个结构。 Kieran Hirpara 4.0

本页面由机器翻译，尚未经临床医生审核。英文版本为权威版本。

您的感受

您可能会注意到手部或手腕出现疼痛、麻木或刺痛。这通常发生在受伤后，或者如果您患有磨损性关节炎等疾病。疼痛可能表现为锐痛或钝痛。疼痛可能在夜间加剧，导致难以入睡。早晨刚醒来时，您可能会感到僵硬。

日常任务可能会变得困难。简单的动作，如伸手到背后扣内衣、塞衬衫下摆或端起一杯咖啡，可能会感觉别扭或疼痛。由于握力减弱，您可能会更频繁地掉落物品。如果您有神经损伤，您可能会感觉手部反应不如以往。这会使持物感觉不稳定。

长时间使用手部后，疼痛通常会加重。休息通常有助于缓解疼痛。然而，如果忽视症状，不适感可能会持续存在。您可能会发现自己在避免某些动作以保护手部。这可能导致随着时间的推移出现僵硬。

如果您有神经损伤，您可能会注意到感觉的变化。有些人报告说手指感觉麻木或像“睡着了”。在某些情况下，您可能会感到烧灼痛或放射痛。这通常与神经周围的肿胀或瘢痕有关。如果您有肌腱损伤，受伤时您可能会听到“啪”的一声或感到突然的断裂感。之后，您可能难以完全弯曲或伸直手指。

注意这些体征非常重要。如果您有骨折，神经和肌腱损伤的风险更高。如果不适当治疗，这可能导致长期残疾。伸肌腱损伤很常见，早期识别是管理的关键。屈肌腱损伤较少见，尤其是在儿童中，但仍需仔细关注。

如果您正在经历这些症状，及时转诊至上肢专科医生有助于优化您的预后。我们希望了解您的感受，以便为您的康复规划最佳路径。

实际发生了什么

您的手依靠由肌腱、神经和韧带组成的复杂系统来实现运动和感觉。肌腱像强韧的绳索，将您的肌肉连接到骨骼上。它们拉动您的手指和拇指以产生运动。神经是传输信号的导线，将来自大脑的信号传递到手部。它们告诉您的肌肉何时运动，并将感觉信号传回大脑。韧带是坚韧的带状组织，将您的骨骼保持在正确的位置。

当您损伤这些结构时，该系统就会失效。断裂的肌腱可能会从骨骼上分离，导致您无法弯曲手指。受损的神经会阻止信号到达肌肉。这会导致无力或麻木。您可能会注意到握力减弱，尤其是在握住小物体时。简单的任务，如握拳，可能会变得缓慢或疼痛。覆盖在骨骼表面的光滑涂层，称为软骨，可能会磨损。这会在关节中产生摩擦和僵硬。

您的外科医生会查看具体的损伤情况以规划修复方案。例如，如果神经被拉伸或切断，我们可能会尝试直接将其重新连接。如果神经损伤过于严重，我们可能会使用肌腱转移术。这涉及移动一根功能正常的肌腱来接管受损肌腱的工作。当无法进行直接神经修复时，这可以恢复功能。在某些情况下，我们会将神经修复与肌腱转移相结合，以改善手部抓握和释放物体的能力。

感觉是康复的关键部分。它在拇指或指尖修复的目标中占40%。长度和外观占其余的50%。我们的目标不仅是恢复运动，还要恢复有助于您安全使用手部的感觉。您的外科医生将根据受伤的位置和严重程度选择最佳方法。目标是让您恢复在日常生活中使用手部。

我们能做什么

针对手部肌腱或神经损伤的治疗方案，取决于损伤发生的时间长短及其对您日常生活的影响。Mater Private Hospital Rockhampton 的上肢外科医生 Kieran Hirpara 博士以安全恢复您的功能为核心制定护理方案。患者通过全科医生或物理治疗师转诊至我们的诊所。通过临床评估（包括病史采集、体格检查以及必要时进行的影像学检查）确立诊断。对于退行性或长期存在的问题，我们通常首先尝试非手术治疗。这包括调整活动方式、物理治疗或手部治疗、夹板固定以及注射治疗。当非手术治疗未能带来足够改善时，我们会考虑手术。对于结构性或急性问题，可能会立即建议手术，而无需先进行非手术治疗的尝试。

在早期阶段，您的物理治疗师会指导您进行轻柔的活动，以保持关节灵活性并防止僵硬。目的是在受伤组织愈合期间维持周围肌肉的力量。如果您感到疼痛，您的外科医生可能会建议服用非处方止痛药或抗炎药以帮助缓解不适。对于某些疾病，如儿童的扳机指或特定的肌腱问题，我们可能会讨论注射治疗。皮质类固醇注射可以减少炎症和疼痛，通常可提供数周至数月的缓解。透明质酸或富血小板血浆（PRP）注射有时用于支持组织健康，尽管疗效持续时间各不相同。我们会根据您的具体损伤和疼痛程度量身定制这些方案。

当保守治疗达到极限或出于安全考虑需要立即修复时，会考虑手术。对于肌腱切割伤，如果您早期就诊且伤口清洁，可以进行一期修复；否则，可能需要肌腱移植。神经损伤较为复杂。如果神经断裂，我们可能会尝试直接修复或使用神经移植桥接缺损。对于小于 2 厘米的缺损，胶原导管可以可靠地恢复功能。如果神经修复不可行或无法恢复有用功能，我们可能会建议肌腱转移术。该手术利用功能正常的肌腱来接管受损肌腱的工作。对于桡神经麻痹，肌腱转移术为神经重建提供了一种重要的替代方案，特别是在早期重返工作岗位至关重要的情况下。在四肢瘫病例中，联合使用神经和肌腱转移术以恢复抓握和释放功能。我们会与您讨论这些选项，确保您在 proceeding 之前充分了解潜在的益处和风险。

预期情况

您的恢复取决于具体的损伤类型及所选择的治疗方案。如果您存在神经损伤，感觉功能的恢复可能缓慢且不彻底。在成人中，仅 24% 的修复后单指神经能恢复至接近或等同于预估的伤前感觉水平。这意味着大多数人将遗留一定程度的永久性感觉改变。然而，如果您进行了指端再植术且未进行神经修复，在两年随访时仍可获得充分的感觉恢复。

当单纯神经修复无法恢复有用功能时，您的外科医生可能会建议进行肌腱转移术。该手术利用有功能的肌腱替换受损肌腱。这是桡神经、正中神经或尺神经损伤的一种有效选择。如果您希望尽早重返工作岗位和社会生活，这可能为首选方案。部分证据表明，对于孤立性桡神经麻痹，肌腱转移术相比神经转移术可提供更高比例的优良临床结果。

您也可同时接受神经修复和肌腱转移术。这种联合方案未显示有害结果，且可能比单纯肌腱转移术提供更好的功能改善。对于伴有 9 厘米或更大缺损的高位桡神经损伤，在进展至肌腱转移术之前，尝试在 8 个月内进行神经重建似乎是适应证。如果您就诊较早且能耐受较长的功能恢复时间，您可能比肌腱转移术更适合接受神经转移术。

康复是您预后的重要组成部分。手部肌腱修复术后的早期康复有益。制定针对您特定肌腱病理和手术情况的个体化康复方案至关重要。诸如 A1 滑车切开松解术等术后，大多数不良后果为短期疼痛、僵硬和肿胀。神经损伤或深部感染等主要并发症并不常见。

若对与骨折相关的神经和肌腱损伤不予处理，长期残疾的风险较高。若管理得当，许多患者可恢复显著功能。肌腱转移术为显微神经重建提供了重要的替代方案。当神经手术修复不可行或无法恢复有用功能时，它有助于恢复功能。您的外科医生将讨论哪种路径最能满足您的特定需求。

何时就诊

若疼痛持续且休息后无改善，或手部出现突发无力和不稳，请寻求专科医生评估。若手指出现交锁或无力，或症状干扰睡眠或工作，请立即就医。骨折与神经和肌腱损伤风险增加相关，可能导致长期残疾。早期识别伸肌腱损伤是治疗的关键。对于高位桡神经损伤且缺损≥9 cm的患者，在行肌腱转移术之前，于8个月内尝试神经重建似乎是适应证。及时转诊有助于优化预后。

Reviewed by AI synthesis (v2) — pending human review · 18 May 2026.

Want the clinical detail? Read the clinician version.

Talk to your treating clinician for advice specific to you.

For an appointment with the CQ Hand + Upper Limb team, ask your GP about a referral or visit www.cqupperlimb.com.

Evidence & references

This is the clinical evidence summary written for health professionals. It is technical, and it lists the research this page was built from. You do not need to read it to understand your treatment or to make a decision about it.

Overview

  • Early neurorrhaphy of acute nerve injuries provides the best outcome [1].
  • Distal motor nerve transfers should be considered to preserve hand intrinsic motor function when nerve injuries occur at or above the proximal forearm [1].
  • Nerve transfer is favored over nerve grafting in managing high ulnar nerve injuries because of better improvement of motor power and better restoration of grip functions of the hand [5].
  • In lower-type injuries of the brachial plexus, transfer of median nerve branches that innervate the palm of the hand to the ulnar proper digital nerve of the little finger predictably restored protective sensation on the ulnar side of the hand [6].
  • End-to-side distal anterior interosseous nerve transfer provides significantly better results than a standard more proximal nerve repair in the treatment of proximal ulnar nerve injuries [12].
  • Vascularized ulnar nerve grafts should be recommended for reconstruction of the median or radial nerves in selected cases involving large defects after severe trauma of the upper extremity [14].
  • High median nerve injuries result in absent thumb and index finger flexion and pulp anesthesia, which do not benefit from nerve grafting but are amenable to nerve transfers [25].
  • Tendon transfers remain the primary reconstructive procedure for paralytic injuries of the upper limb until sufficiently powered studies of nerve transfer outcomes are published [36].
  • Experimental studies and positive reports from large clinical series suggest that new techniques using foreign nerves for reinnervation are worthy of integration into the management of upper brachial plexus injuries, though many questions regarding timing, donor morbidity, and comparative efficacy remain unanswered [11].
  • Clinically, nerve transfer to the median nerve using parts of the ulnar and radial nerves may offer an alternative option for proximal nerve injuries or for free functioning muscle transplantations [16].
  • The biomechanical principles, indications and limitations of tendon transfers, nerve transfers and combined approaches are compared, with particular attention to timing, patient selection, and functional goals [3].

Anatomy & Pathophysiology

  • High median nerve transection results in a specific clinical presentation of hand function [2].
  • Biomechanical principles, indications, and limitations of tendon transfers, nerve transfers, and combined approaches depend on timing, patient selection, and functional goals [3].
  • Ballistic injuries to the hand are frequently associated with fractures and neurovascular and tendon injuries [4].
  • Upper extremity peripheral nerve injuries involve the median, radial, and ulnar nerves [8].
  • A nerve transfer for restoration of ulnar finger flexion through the pronator teres motor branch can be suggested in cases where the hand is partially involved to allow patients to regain or strengthen finger flexion [9].
  • Functional prehension requires a stable wrist and at least two sensate digits that can oppose with some power [10].
  • Severe hand injuries from sword assaults can cause devastating loss of function [15].
  • In combined proximal median and ulnar nerve injuries, restoring ulnar intrinsic function is critical to avoid blunt traditional anticlaw procedures, even if it requires some sacrifice of thumb motors [23].
  • Opposition transfers do not require large amounts of strength to achieve thumb positioning; the mechanics and vector of pull are of paramount importance [28].
  • An ulnar nerve to musculocutaneous nerve transfer in an ulnar ray-deficient infant with brachial plexus birth palsy resulted in active elbow flexion to 90° at 18 months without motor deficits in the hand [30].
  • Opposition is a preparatory position for grasp involving abduction, flexion, and pronation, primarily driven by the thenar intrinsic muscles [31].
  • A distally based extensor digiti minimi tendon transfer maximizes adducting force and overcomes reciprocal inhibition to correct a persistently abducted little finger [32].
  • There is no significant difference in hand function between border and central finger digital nerve injuries, except for lower grip strength in central finger injuries [33].
  • Outcomes for pediatric mutilating hand injuries tend to be better than in adults regarding mobility, sensory return, and appearance [37].
  • The quadriga phenomenon is caused by interconnected flexor digitorum profundus tendons and significantly affects clinical situations including strength testing, movement assessment, and rehabilitation exercise selection [39].

Classification

  • High median nerve transection presents with preserved finger flexion [2].
  • Tendon transfers, nerve transfers, and combined approaches are distinguished by their biomechanical principles, indications, limitations, timing, patient selection, and functional goals [3].
  • Nerve transfer is favored over nerve grafting in managing high ulnar nerve injuries due to better improvement of motor power and better restoration of grip functions [5].
  • Transfer of median nerve branches that innervate the palm of the hand to the ulnar proper digital nerve of the little finger predictably restores protective sensation on the ulnar side of the hand in lower-type brachial plexus injuries [6].
  • Transfer of the superficial radial or dorsal cutaneous branch of the ulnar nerve, or both, produces successful restoration of innervation of the thumb, index, and long fingers in experimental sensory reinnervation models [7].
  • Upper extremity peripheral nerve injuries include median, radial, and ulnar nerve injuries [8].
  • Nerve transfer for restoration of ulnar finger flexion through the pronator teres motor branch can be suggested in cases where the hand is partially involved to allow patients to regain or strengthen finger flexion [9].
  • Vascularized ulnar nerve grafts should be recommended for reconstruction of median or radial nerves in selected cases with large defects after severe upper extremity trauma [14].
  • Diagnosis-specific model instruments for outcome after nerve repair at the wrist or distal forearm level include new test instruments for assessment of tactile gnosis [21].
  • Supercharged end-to-side anterior interosseous nerve transfer (SETS) exhibits a remarkable role in treating high ulnar nerve damage by supplying intrinsic muscles and allowing for proximal nerve regeneration [27].
  • A reliable tendon prosthesis inserted as one stage in tendon reconstruction is an additional step needed to improve results of flexor-tendon reconstructive surgery in hands with severe damage [40].

Clinical Presentation

  • High median nerve transection can present with preserved finger flexion [2].
  • Transfer of the superficial radial or dorsal cutaneous branch of the ulnar nerve, or both, produced successful restoration of innervation of the thumb and index and long fingers [7].
  • Upper extremity peripheral nerve injuries present to emergency departments [8].
  • Nerve transfer for restoration of ulnar fingers flexion through the pronator teres motor branch can be suggested in cases where the hand is partially involved to allow patients to regain or strengthen finger flexion [9].
  • End-to-side distal anterior interosseous nerve transfer in treatment of proximal ulnar nerve injuries provides significantly better results than a standard more proximal nerve repair [12].
  • The triad of multiple metacarpal fractures and/or dislocations of the fingers, severe hand swelling, and clinical evidence of acute median nerve dysfunction can occur [13].
  • Severe hand injuries resulting from sword assaults can cause devastating loss of function [15].
  • The choice of surgical technique and timing for peripheral nerve injury depends on the type of trauma, site of injury, and time elapsed since injury [17].
  • Spontaneous recovery occurs in 70%–88% of radial nerve injuries [17].
  • Direct radial to ulnar nerve transfer via an interosseous tunnel safely and effectively restored intrinsic function before terminal muscle degeneration in a patient with combined proximal median and ulnar nerve injury [19].
  • The prognosis for recovery of peripheral neuropathies is good unless the nerve has been completely destroyed [22].
  • Traumatic neurapraxia in digital nerve injuries of the hand is not uncommon and has a favourable prognosis [29].

Investigations

  • Evaluation based only on a photograph taken in the emergency department was insufficient for the detection of neurovascular bundle injuries, tendon ruptures, and fractures [43].
  • The hand requires a stable wrist and at least two sensate digits that can oppose with some power for functional prehension [10].

Treatment

  • Transfer of the superficial radial or dorsal cutaneous branch of the ulnar nerve, or both, produced successful restoration of innervation of the thumb and index and long fingers in experimental sensory reinnervation models [7].
  • Nerve transfer using the pronator teres motor branch can be suggested in cases where the hand is partially involved to allow patients to regain or strengthen finger flexion [9].
  • Experimental studies and positive reports from large clinical series suggest that new techniques using foreign nerves for reinnervation are worthy of integration into the management of upper brachial plexus injuries [11].
  • Clinically, nerve transfer using parts of the ulnar and radial nerves may offer an alternative option for proximal nerve injuries or for free functioning muscle transplantations [16].
  • Distal nerve transfers for the treatment of high ulnar nerve injuries allow for a shorter reinnervation period and improved ulnar intrinsic recovery, which is critical to function of the hand [18].
  • The thenar branch of the median nerve may support ulnar nerve regeneration and help prevent intrinsic muscles from irreversible atrophy, though the procedure requires validation by future clinical data [20].
  • In devastating combined proximal median and ulnar nerve injuries, some sacrifice of thumb motors may be necessary to restore ulnar intrinsic function and avoid blunt traditional anticlaw procedures [23].
  • Early nonsurgical management for up to 6 months in adults and 9 months in children has expanded from closed humeral shaft fractures to include operative fractures that do not require nerve exposure, secondary palsies, and distal third humerus fractures [26].
  • Supercharged end-to-side anterior interosseous nerve transfer (SETS) exhibits a remarkable role in the treatment of high ulnar nerve damage by supplying intrinsic muscles and allowing for proximal nerve regeneration [27].
  • The thenar motor branch (OP branch) consistently reached the deep terminal motor branch of the ulnar nerve without tension, supporting its use to restore pinch after ulnar nerve injuries [35].
  • When nonoperative treatment fails, tendon transfers may be used for ulnar nerve injuries, with preferred options including ECRB to AP, APL to first DI, and splint FPL to EPL transfers evaluated on an individual basis [41].

Complications

  • Full recovery of median nerve function was seen in all patients with the triad of multiple metacarpal fractures/dislocations, severe hand swelling, and acute median nerve dysfunction at a mean final follow-up of 7 months [13].
  • All patients with the triad of multiple metacarpal fractures/dislocations, severe hand swelling, and acute median nerve dysfunction were able to return to work [13].
  • High ulnar nerve injuries can result in loss of ulnar intrinsic motor function [1].
  • High ulnar nerve injuries can lead to irreversible atrophy of intrinsic muscles [20].
  • Nerve transfers have revolutionized care for peripheral nerve injuries [24].

Recovery

  • Nerve transfer is favored over nerve grafting in managing high ulnar nerve injuries because of better improvement of motor power [5].
  • Nerve transfer is favored over nerve grafting in managing high ulnar nerve injuries because of better restoration of grip functions of the hand [5].
  • Transfer of the superficial radial or dorsal cutaneous branch of the ulnar nerve, or both, produced successful restoration of innervation of the thumb and index and long fingers in experimental sensory reinnervation studies [7].
  • The hand requires a stable wrist for functional prehension [10].
  • The hand requires at least two sensate digits that can oppose with some power for functional prehension [10].
  • New techniques using foreign nerves for reinnervation are worthy of integration into the management of upper brachial plexus injuries, though many questions regarding timing, donor morbidity, and comparative efficacy remain unanswered [11].
  • At a mean final follow-up of 7 months, full recovery of median nerve function was seen in all patients with the triad of multiple metacarpal fractures/dislocations, severe hand swelling, and acute median nerve dysfunction [13].
  • Nerve transfer to the median nerve using parts of the ulnar and radial nerves may offer an alternative option for proximal nerve injuries or for free functioning muscle transplantations [16].
  • The choice of surgical technique and timing for peripheral nerve injury of the upper extremity depends on the type of trauma, site of injury, and time elapsed since injury [17].
  • Distal nerve transfers for the treatment of high ulnar nerve injuries allow for a shorter reinnervation period [18].
  • Distal nerve transfers for the treatment of high ulnar nerve injuries allow for improved ulnar intrinsic recovery [18].
  • Improved ulnar intrinsic recovery is critical to function of the hand [18].
  • Additional long-term follow-up and case series are warranted for nerve transfers in peripheral nerve injuries [24].
  • Early nonsurgical management for up to 6 months in adults is indicated for radial nerve injuries associated with closed humeral shaft fractures [26].
  • Early nonsurgical management for up to 6 months in adults is indicated for radial nerve injuries associated with operative fractures that do not require nerve exposure [26].
  • Early nonsurgical management for up to 6 months in adults is indicated for radial nerve injuries associated with secondary palsies [26].
  • Early nonsurgical management for up to 6 months in adults is indicated for radial nerve injuries associated with distal third humerus fractures [26].
  • Early nonsurgical management for up to 9 months in children is indicated for radial nerve injuries associated with closed humeral shaft fractures [26].
  • Scarring from injury or previous surgery compromises results in flexor-tendon grafts in the fingers and thumb [44].
  • Joint stiffness compromises results in flexor-tendon grafts in the fingers and thumb [44].
  • Nerve damage compromises results in flexor-tendon grafts in the fingers and thumb [44].
  • The level of injury does not influence results in flexor-tendon grafts in the fingers and thumb [44].
  • Time to operation does not influence results in flexor-tendon grafts in the fingers and thumb [44].

Key Evidence

  • [L5] Early neurorrhaphy of acute nerve injuries provides the best outcome, but consideration should also be given to performing distal motor nerve transfers to preserve hand intrinsic motor function when injuries occur at or above the proximal forearm. [1] (10.1016/j.jhsa.2014.04.038)
  • [Case_report] This case contributes further to our understanding of the clinical presentation of hand function following high median nerve transection. [2] (10.1186/s12891-025-08469-3)
  • [L5] The biomechanical principles, indications and limitations of tendon transfers, nerve transfers and combined approaches are compared, with particular attention to timing, patient selection, and functional goals. [3] (10.1177/17531934261416300)
  • [L4] Ballistic injuries to the hand are frequently associated with fractures and neurovascular and tendon injuries. [4] (10.1177/15589447221092111)
  • [L4] Nerve transfer is favored over nerve grafting in managing high ulnar nerve injuries because of better improvement of motor power and better restoration of grip functions of the hand. [5] (10.1016/j.jhsa.2017.01.027)
  • [L4] In lower-type injuries of the brachial plexus, transfer of median nerve branches that innervate the palm of the hand to the ulnar proper digital nerve of the little finger predictably restored protective sensation on the ulnar side of the hand. [6] (10.1016/j.jhsa.2012.02.047)
  • [L5] Transfer of the superficial radial or dorsal cutaneous branch of the ulnar nerve, or both, produced successful restoration of innervation of the thumb and index and long fingers. [7] (10.2106/00004623-197759030-00016)
  • [L4] This study provides a critical overview of upper extremity peripheral nerve injuries. [8] (10.1016/j.jht.2026.02.012)
  • [L5] This specific procedure can be suggested in cases where the hand is partially involved to allow patients to regain or strengthen fingers flexion. [9] (10.1016/j.jhsg.2025.100844)
  • [L5] The hand requires a stable wrist and at least two sensate digits that can oppose with some power for functional prehension. [10] (10.1016/s0749-0712(02)00130-0)
  • [L5] Experimental studies and positive reports from large clinical series suggest that new techniques using foreign nerves for reinnervation are worthy of integration into the management of upper brachial plexus injuries, though many questions regarding timing, donor morbidity, and comparative efficacy remain unanswered. [11] (10.1054/jhsb.2000.0460)
  • [L4] It provides significantly better results than a standard more proximal nerve repair. [12] (10.1016/s0363-5023(11)60008-7)
  • [L4] At a mean final follow-up of 7 months, full recovery of median nerve function was seen in all patients, and all patients were able to return to work. [13] (10.1177/1753193408087105)
  • [L4] This technique should be recommended for reconstruction of the median or radial nerves in selected cases. [14] (10.1016/j.jhsa.2005.03.017)
  • [L4] This case series demonstrates the extent and severity of hand injuries that can be caused by sword assaults with devastating loss of function for the victims. [15] (10.1177/1753193410381576)
  • [L5] Clinically, this technique may offer an alternative option for proximal nerve injuries or for free functioning muscle transplantations. [16] (10.1054/jhsb.2000.0389)
  • [L4] The choice of surgical technique and timing depends on the type of trauma, site of injury, and time elapsed since injury, with spontaneous recovery occurring in 70%–88% of radial nerve injuries. [17] (10.1177/17531934241240867)
  • [L5] Distal nerve transfers for the treatment of high ulnar nerve injuries allow for a shorter reinnervation period and improved ulnar intrinsic recovery, which is critical to function of the hand. [18] (10.1016/j.hcl.2015.12.009)
  • [Case_report] Direct radial to ulnar nerve transfer via an interosseous tunnel safely and effectively restored intrinsic function before terminal muscle degeneration in a patient with combined proximal median and ulnar nerve injury. [19] (10.1016/j.jhsa.2014.04.013)
  • [L4] The thenar branch of the median nerve may support ulnar nerve regeneration and help prevent intrinsic muscles from irreversible atrophy, but the report is preliminary and the procedure should be validated by future clinical data. [20] (10.1177/1753193416675069)
  • [L5] The paper reviews the developmental process of a diagnosis-specific Model instrument for outcome after nerve repair at wrist or distal forearm level, including a new test instrument for assessment of tactile gnosis. [21] (10.1016/s0749-0712(03)00003-9)
  • [L3] The prognosis for recovery is good unless the nerve has been completely destroyed. [22] (10.2106/00004623-197658010-00011)
  • [Letter] The authors acknowledge the concerns regarding potential thumb function loss but emphasize the critical need to restore ulnar intrinsic function to avoid blunt traditional anticlaw procedures, suggesting that some sacrifice of thumb motors may be necessary in devastating combined proximal median and ulnar nerve injuries. [23] (10.1016/j.jhsa.2014.10.067)
  • [Letter] The original authors state that nerve transfers have revolutionized care for peripheral nerve injuries and that additional long-term follow-up and case series are warranted. [24] (10.1016/j.jhsa.2014.07.058)
  • [L4] High median nerve injuries result in absent thumb and index finger flexion and pulp anesthesia, which do not benefit from nerve grafting but are amenable to nerve transfers. [25] (10.1016/j.hcl.2015.12.008)
  • [L5] Early nonsurgical management for up to 6 months in adults and 9 months in children has expanded from closed humeral shaft fractures to include operative fractures that do not require nerve exposure, secondary palsies, and distal third humerus fractures. [26] (10.5435/jaaos-d-17-00325)
  • [L4] SETS exhibit a remarkable role in the treatment of high ulnar nerve damage by supplying intrinsic muscles and allowing for proximal nerve regeneration. [27] (10.1186/s12891-024-07650-4)
  • [L5] Opposition transfers do not require large amounts of strength to achieve the goal of thumb positioning; the mechanics and vector of pull are of paramount importance. [28] (10.1016/j.hcl.2016.03.005)
  • [L4] Traumatic neurapraxia in digital nerve injuries of the hand is not uncommon and has a favourable prognosis. [29] (10.1007/s00402-007-0299-6)
  • [Case_report] The procedure resulted in active elbow flexion to 90° at 18 months without motor deficits in the hand. [30] (10.1016/j.jhsa.2010.06.014)
  • [L5] Opposition is a preparatory position for grasp involving abduction, flexion, and pronation, primarily driven by the thenar intrinsic muscles. [31] (10.1016/j.hcl.2011.09.004)
  • [L4] The novel tendon transfer technique maximizes adducting force and overcomes reciprocal inhibition, resulting in normal finger position at 9 months. [32] (10.1177/1753193411421096)
  • [L3] No significant difference was seen in hand function between border and central finger injuries, except for lower grip strength in central finger injuries. [33] (10.1177/17531934241286116)
  • [L4] The OP branch consistently reached the deep terminal motor branch of the ulnar nerve without tension, supporting its use to restore pinch after ulnar nerve injuries. [35] (10.1177/17531934251389494)
  • [L5] Tendon transfers remain the primary reconstructive procedure for paralytic injuries of the upper limb until sufficiently powered studies of nerve transfer outcomes are published. [36] (10.1177/1753193419864838)
  • [L5] The treatment of mutilating hand injuries in children is challenging but outcomes tend to be better than in adults regarding mobility, sensory return, and appearance. [37] (10.1016/s0749-0712(02)00076-8)
  • [L5] The authors welcome interest in their work on nerve transfers for complex injuries, stating that while no perfect strategies exist, nerve transfers have revolutionized care and that additional long-term follow-up and case series are warranted. [38] (10.1016/j.jhsa.2014.10.007)
  • [L5] The quadriga phenomenon, caused by interconnected flexor digitorum profundus tendons, significantly affects clinical situations including strength testing, movement assessment, and rehabilitation exercise selection; understanding its anatomy and biomechanics improves diagnosis and treatment. [39] (10.1177/1753193411430810)
  • [L4] The authors conclude that a reliable tendon prosthesis inserted as one stage in tendon reconstruction is the additional step needed to improve the results of flexor-tendon reconstructive surgery in hands with severe damage. [40] (10.2106/00004623-197153050-00001)
  • [L5] When nonoperative treatment fails, tendon transfers may be used, with preferred options including ECRB to AP, APL to first DI, and splint FPL to EPL transfers evaluated on an individual basis. [41] (10.1016/j.hcl.2016.03.007)
  • [L4] Similarly, evaluation based only on the photograph was insufficient for the detection of neurovascular bundle injuries, tendon ruptures, and fractures. [43] (10.1016/j.jhsa.2024.07.009)

References

[1] Management of Ulnar Nerve Injuries. The Journal of Hand Surgery. 2015. DOI: 10.1016/j.jhsa.2014.04.038

[2] Preserved finger flexion following high median nerve transection: a rare case report and review of literature. BMC Musculoskeletal Disorders. 2025. DOI: 10.1186/s12891-025-08469-3

[3] Tendon versus nerve transfers – balancing hand function in upper extremity high nerve injuries. Journal of Hand Surgery (European Volume). 2026. DOI: 10.1177/17531934261416300

[4] Outcomes in Ballistic Injuries to the Hand: Fractures and Nerve/Tendon Damage as Predictors of Poor Outcomes. HAND. 2022. DOI: 10.1177/15589447221092111

[5] Nerve Transfer Versus Nerve Graft for Reconstruction of High Ulnar Nerve Injuries. The Journal of Hand Surgery. 2017. DOI: 10.1016/j.jhsa.2017.01.027

[6] Distal Sensory Nerve Transfers in Lower-Type Injuries of the Brachial Plexus. The Journal of Hand Surgery. 2012. DOI: 10.1016/j.jhsa.2012.02.047

[7] Experimental sensory reinnervation of the median nerve by nerve transfer in monkeys. The Journal of Bone & Joint Surgery. 1977. DOI: 10.2106/00004623-197759030-00016

[8] Exploring 20 years of peripheral nerve injuries of the upper extremity: An analysis of median, radial, and ulnar nerve injuries presenting to US emergency departments. Journal of Hand Therapy. 2026. DOI: 10.1016/j.jht.2026.02.012

[9] Nerve Transfer for Restoration of Ulnar Fingers Flexion Through Pronator Teres Motor Branch: A Cadaveric Feasibility Study. Journal of Hand Surgery Global Online. 2026. DOI: 10.1016/j.jhsg.2025.100844

[10] Biomechanics and hand trauma: what you need. Hand Clinics. 2003. DOI: 10.1016/s0749-0712(02)00130-0

[11] Avulsion Injuries to the Brachial Plexus and the Value of Motor Reinnervation by Ipsilateral Nerve Transfer. Journal of Hand Surgery. 2000. DOI: 10.1054/jhsb.2000.0460

[12] End-to-side Distal Anterior Interosseous Nerve Transfer in Treatment of Proximal Ulnar Nerve Injuries. The Journal of Hand Surgery. 2011. DOI: 10.1016/s0363-5023(11)60008-7

[13] The Triad of Multiple Metacarpal Fractures and/or Dislocations of the Fingers, Severe Hand Swelling and Clinical Evidence of Acute Median Nerve Dysfunction. Journal of Hand Surgery (European Volume). 2008. DOI: 10.1177/1753193408087105

[14] Vascularized Ulnar Nerve Graft for Reconstruction of a Large Defect of the Median or Radial Nerves After Severe Trauma of the Upper Extremity. The Journal of Hand Surgery. 2005. DOI: 10.1016/j.jhsa.2005.03.017

[15] Severe hand injuries resulting from Samurai sword assaults: a Dublin case series. Journal of Hand Surgery (European Volume). 2010. DOI: 10.1177/1753193410381576

[16] Nerve Transfer to the Median Nerve Using Parts of the Ulnar and Radial Nerves in the Rabbit – Effects on Motor Recovery of the Median Nerve and Donor Nerve Morbidity. Journal of Hand Surgery. 2000. DOI: 10.1054/jhsb.2000.0389

[17] Timing of surgery in peripheral nerve injury of the upper extremity. Journal of Hand Surgery (European Volume). 2024. DOI: 10.1177/17531934241240867

[18] High Ulnar Nerve Injuries. Hand Clinics. 2016. DOI: 10.1016/j.hcl.2015.12.009

[19] Direct Radial to Ulnar Nerve Transfer to Restore Intrinsic Muscle Function in Combined Proximal Median and Ulnar Nerve Injury: Case Report and Surgical Technique. The Journal of Hand Surgery. 2014. DOI: 10.1016/j.jhsa.2014.04.013

[20] Nerve grafts bridging the thenar branch of the median nerve to the ulnar nerve to enhance nerve recovery: a report of three cases. Journal of Hand Surgery (European Volume). 2016. DOI: 10.1177/1753193416675069

[21] A new model instrument for outcome after nerve repair. Hand Clinics. 2003. DOI: 10.1016/s0749-0712(03)00003-9

[22] Peripheral neuropathies associated with total hip arthroplasty. The Journal of Bone & Joint Surgery. 1976. DOI: 10.2106/00004623-197658010-00011

[23] Response to “Direct Radial to Ulnar Nerve Transfer to Restore Intrinsic Muscle Function in Combined Proximal Median and Ulnar Nerve Injury: Case Report and Surgical Technique”. The Journal of Hand Surgery. 2015. DOI: 10.1016/j.jhsa.2014.10.067

[24] Letter to the Editor Regarding Phillips BZ, Franco MJ, Yee A, Tung TH, Mackinnon SE, Fox IK. Direct Radial to Ulnar Nerve Transfer to Restore Intrinsic Muscle Function in Combined Proximal Median and Ulnar Nerve Injury: Case Report and Surgical Technique. J Hand Surg Am. 2014;39(7):1358–1362. The Journal of Hand Surgery. 2015. DOI: 10.1016/j.jhsa.2014.07.058

[25] High Median Nerve Injury. Hand Clinics. 2016. DOI: 10.1016/j.hcl.2015.12.008

[26] Updates on and Controversies Related to Management of Radial Nerve Injuries. Journal of the American Academy of Orthopaedic Surgeons. 2019. DOI: 10.5435/jaaos-d-17-00325

[27] Supercharged end-to-side anterior interosseous nerve transfer to restore intrinsic function in high ulnar nerve injury: a prospective cohort study. BMC Musculoskeletal Disorders. 2024. DOI: 10.1186/s12891-024-07650-4

[28] Low Median Nerve Transfers (Opponensplasty). Hand Clinics. 2016. DOI: 10.1016/j.hcl.2016.03.005

[29] Clinical and user-friendly classification of traumatic digital nerve injuries of hand. Archives of Orthopaedic and Trauma Surgery. 2007. DOI: 10.1007/s00402-007-0299-6

[30] Ulnar Nerve to Musculocutaneous Nerve Transfer in an Ulnar Ray–Deficient Infant With Brachial Plexus Birth Palsy: Case Report. The Journal of Hand Surgery. 2010. DOI: 10.1016/j.jhsa.2010.06.014

[31] Restoration of Opposition. Hand Clinics. 2012. DOI: 10.1016/j.hcl.2011.09.004

[32] Correcting the persistently abducted little finger using a distally based extensor digiti minimi tendon. Journal of Hand Surgery (European Volume). 2011. DOI: 10.1177/1753193411421096

[33] Long-term subjective and objective outcomes after digital nerve repair: a cohort study. Journal of Hand Surgery (European Volume). 2024. DOI: 10.1177/17531934241286116

[35] Anatomical roadmap of the thenar motor branches: key insights for distal nerve transfers. Journal of Hand Surgery (European Volume). 2025. DOI: 10.1177/17531934251389494

[36] Tendon transfers after peripheral nerve injuries: my preferred techniques. Journal of Hand Surgery (European Volume). 2019. DOI: 10.1177/1753193419864838

[37] Pediatric mutilating hand injuries. Hand Clinics. 2003. DOI: 10.1016/s0749-0712(02)00076-8

[38] In Reply:. The Journal of Hand Surgery. 2015. DOI: 10.1016/j.jhsa.2014.10.007

[39] The quadriga phenomenon: a review and clinical relevance. Journal of Hand Surgery (European Volume). 2011. DOI: 10.1177/1753193411430810

[40] Flexor-Tendon Reconstruction in Severely Damaged Hands. The Journal of Bone & Joint Surgery. 1971. DOI: 10.2106/00004623-197153050-00001

[41] Ulnar Nerve Tendon Transfers for Pinch. Hand Clinics. 2016. DOI: 10.1016/j.hcl.2016.03.007

[43] Evaluation of Injured Structures and Circulation of Fingers From Photos Taken in the Emergency Department After Hand Injury. The Journal of Hand Surgery. 2024. DOI: 10.1016/j.jhsa.2024.07.009

[44] Flexor-Tendon Grafts in the Fingers and Thumb: A STUDY OF FACTORS INFLUENCING RESULTS IN 1000 CASES.. The Journal of Bone and Joint Surgery. American Volume. 1971.

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