Hand Center Recent Publications

Brachial plexus injuries typically involve damage to the nerve roots that control the arm and hand, but this study identified a rare pattern where patients retained some finger flexion despite suffering a complete brachial plexus injury. Researchers reviewed 989 surgical patients treated between 2010 and 2022, identifying 16 cases (1.6%) with this unusual presentation, all of whom showed signs of lower nerve root avulsion and Horner syndrome but maintained partial finger-bending ability. Various nerve transfer surgeries were performed to restore shoulder and elbow function, and follow-up data from 12 patients showed that elbow flexion was successfully recovered in over 90% of cases, though about 29% of patients who had median nerve donor transfers experienced some decline in finger flexion strength. The little finger flexors and certain hand muscles were consistently paralyzed in all cases, helping to define the boundaries of this injury pattern. These findings highlight a previously underrecognized subtype of complete brachial plexus injury, which has important implications for surgical planning and for avoiding donor nerve choices that could further compromise hand function.

Fingertip injuries are one of the most frequent reasons patients visit the emergency department, making it important for clinicians to understand the best approaches to treatment. The goals of management include providing adequate soft-tissue coverage over exposed bone or tendon, preserving the length and function of the finger, maintaining a normal-looking nail, and preventing long-term pain. Bone injuries are usually treated without surgery, though certain cases — such as unstable fractures or jersey finger injuries, where a tendon is torn from the bone — may require surgical intervention. Nail bed injuries are treated based on their severity, ranging from a simple procedure to drain blood trapped under the nail to full removal of the nail plate and surgical repair of the underlying tissue. Soft-tissue damage can be addressed through a range of techniques, from allowing the wound to heal on its own to using skin grafts or tissue flaps from nearby areas of the hand, with most patients achieving good outcomes when treated appropriately.

Traumatic brachial plexus injuries (BPIs) are severe nerve injuries that can result in significant loss of arm and shoulder function, yet no standardized surgical treatment guidelines currently exist. This study surveyed eight expert U.S. surgeons, each independently reviewing the same four real patient cases and providing their preferred surgical reconstruction plans. The results revealed considerable disagreement among surgeons, particularly regarding whether to use nerve grafting, how to restore shoulder stability, and which nerve transfer techniques to prioritize — especially in complex cases involving the entire brachial plexus. Some areas of moderate agreement did emerge, such as favoring triceps-to-axillary nerve transfers and double fascicular transfers for elbow and shoulder function in upper trunk injuries. These findings highlight an urgent need for standardized treatment protocols, as the wide variability in expert recommendations suggests that patients with similar injuries may receive very different care depending on which surgeon they see.

Traumatic brachial plexus injuries (BPIs) are severe nerve injuries that can cause permanent loss of arm function, and surgeons currently lack agreed-upon standards for how to treat them. This study surveyed eight expert BPI surgeons across the United States, asking each to independently review four real patient cases and describe their preferred surgical reconstruction plans. The results revealed significant disagreement among surgeons, particularly regarding whether to use nerve grafting, how to restore shoulder stability, and when to consider shoulder fusion as an early versus later option. Some procedures, such as transferring a nerve branch from the triceps to restore shoulder movement, were more consistently recommended, but no single approach achieved full consensus across cases. These findings highlight the need for standardized treatment guidelines for BPI, as the wide variation in expert opinion suggests that patients may receive meaningfully different care depending on which surgeon they see.

Traumatic brachial plexus injuries (BPIs) are severe nerve injuries that can cause significant loss of arm and shoulder function, yet no standardized surgical treatment guidelines currently exist. This study examined how eight expert American surgeons would approach four real BPI patient cases, each involving different injury patterns and demographics, by having them independently review case files and propose their preferred surgical reconstruction plans. The results revealed considerable disagreement among surgeons, particularly regarding whether to use nerve grafting, how to restore shoulder stability, and which nerve transfer techniques to prioritize — especially in the most severe, pan-plexus injury cases. Some areas of moderate agreement did emerge, such as favoring triceps-to-axillary nerve transfers and double fascicular transfers for upper trunk injuries, but no consensus was reached for restoring shoulder and elbow function when internal nerve sources were unavailable. These findings highlight a critical gap in standardized care for BPI patients and underscore the need for collaborative research and evidence-based guidelines to reduce variability and ultimately improve surgical outcomes.

Peripheral nerve injuries can cause lasting loss of movement and sensation, making effective treatments a critical area of research. This review examines how electrical stimulation (ES) may help nerves regrow and reconnect after injury, exploring the biological mechanisms behind why applying electrical current to damaged nerves might speed up recovery. The authors analyzed findings from both animal studies and human clinical trials to evaluate how well ES works in real-world and laboratory settings. Evidence suggests that ES promotes nerve regeneration by enhancing the expression of growth-related proteins and accelerating the regrowth of nerve fibers toward their targets. The review concludes with current clinical recommendations and highlights promising future directions, positioning ES as a potentially important tool in the treatment of peripheral nerve injuries.

This study investigated how pain interferes with daily life in patients with traumatic brachial plexus injury (BPI) — a serious nerve injury affecting the arm and shoulder — both before and one year after surgery. Researchers tracked 37 patients from a multicenter study, using standardized questionnaires to measure pain interference, depression, anxiety, physical limitations, and emotional recovery, alongside surgeon assessments of muscle function and injury severity. Before surgery, patients reported notably high levels of pain interference, and this did not meaningfully improve one year after surgery, with average scores remaining similarly elevated. At the one-year follow-up, pain interference was strongly linked to pain symptoms, physical limitations, and emotional recovery, while muscle function showed little association with pain interference at either time point. These findings highlight that pain remains a persistent and significant burden for BPI patients even after surgical treatment, suggesting that pain management should be treated as a central priority in care — not just efforts to restore arm and shoulder movement.

This study examined how common it is for medical trainees, faculty, and staff in plastic surgery and urology residency programs to refuse participation in gender-affirming surgeries based on personal, moral, or religious beliefs—a practice known as conscientious objection. Researchers surveyed leadership from 239 accredited U.S. residency programs between February and October 2023, collecting data on training exposure, objection experiences, and whether formal policies existed to handle such situations. Out of 124 programs that responded, 13% had encountered at least one objection to gender-affirming surgery, most often from trainees, while only 19% of programs had formal policies in place to address these situations. Notably, factors like geographic location or the amount of exposure to gender-affirming surgery did not predict whether objections occurred, but programs with formal policies reported feeling more confident in handling future objection events. The findings suggest that while conscientious objection in this context is uncommon, residency programs should proactively develop clear policies to protect patient care and fairly address the needs of objecting providers.

Flexor tendon injuries in the hand require surgical repair, and this article outlines the key principles that surgeons should follow to achieve reliable results. The study focuses particularly on Zone II injuries — located in the finger between the first and second pulleys — which are the most challenging to treat due to the complex anatomy in that region. Surgical techniques have advanced significantly over recent decades, with current best practices emphasizing a core strand repair using at least four strands of suture, an additional epitendinous suture to improve both strength and smooth gliding of the tendon, and strategic venting of the fibrous pulleys to reduce friction. A critical component of successful recovery is initiating active movement of the fingers within three to five days after surgery, as early mobilization helps prevent scar tissue from restricting tendon movement. These guidelines are significant because following them consistently gives patients the best chance of regaining functional hand movement after what can otherwise be a difficult injury to treat.

This case study describes a surgical approach to restoring hand function in a young patient with tetraplegia, a condition involving partial or complete paralysis of all four limbs. The patient had previously undergone a nerve transfer procedure — where the nerve branch controlling the extensor carpi radialis brevis (ECRB) muscle in the forearm was rerouted to restore finger and thumb flexion — but the surgery was unsuccessful. As a follow-up, surgeons performed a tendon transfer using the ECRB tendon itself, physically reconnecting it to restore the bending movements of the thumb and fingers. Twelve months after this second procedure, the patient regained functional grip and pinch strength and was able to use both hands for everyday tasks. This case highlights an important surgical backup strategy: when nerve transfers fail in tetraplegic patients, tendon transfers using the same donor muscle can still achieve meaningful functional recovery.