Superficial radial nerve injury
 

I cut my dorsolateral wrist just proximal to the radial styloid process two weeks ago when a heavy mirror broke and fell on it, and it required seven stitches. There was bruising on the entire dorsal surface of my hand and several inches up my ventral forearm, but that's mostly gone now. Swelling in the hand subsided after a couple of days. It was a pretty deep cut, though not all the way to the bone. Subcutaneous fat was visible. Xray was negative. I removed the stitches yesterday.

Miraculously, the only problem is with the superficial radial nerve. There was some light numbness in my thumb and index finger from the start, but that has gotten a good bit better. I can feel pinprick, heat, cold, etc everywhere, but the dorsomedial thumb is still a tad numb. About a week after the injury, I began to have a sunburn-like feeling over the first interosseus space, extending about an inch over the medial thumb and lateral index finger. Tinel's sign was strongly positive at the site of the laceration at the time of the injury, with shooting pain into the thumb and index finger, and this remains the case. There is still a hematoma under the injury site extending about 10 mm distal to it, and I can elicit the Tinel's sign another 5 mm or so distally.

The laceration was repaired in the ER, but let's just say I was not attended to by a hand surgeon. When I remarked on the positive Tinel's sign, which I think was elicited accidentally and was never characterized by name, the person proceeded to go through some range of motion and strength tests. I have no idea if there was any assessment of nerve damage. Even the triage doc I saw for less than a minute didn't evaluate for sensory defects, just motion.

Now, of course, I'm wondering how badly I injured the nerve.

If it was transected, wouldn't I have complete anesthesia, and wouldn't the Tinel sign not radiate into the digits? I can't seem to find any discussion of this. If I'm correct in thinking it wasn't transected, then it was either nicked or crushed. If it was nicked, can it heal without forming a neuroma? Is it possible it was just bruised, and the Tinel sign remains due to compression by the hematoma? The Tinel only extends just past the edge of the hematoma, and if it's due to the compression, well, I can't say that it's advancing. In any case, it remains at the injury site. How long does a Tinel's sign take to resolve? And what about the sunburn-like feeling that had delayed onset? Wallerian degeneration? How much longer should I wait before seeking follow-up? This is not debilitating, just annoying and somewhat limiting. I can type this message fine, but it's still very sensitive to touch, and while I have full strength, I avoid motions that can stretch the area.

Hello sawfish: I cannot comment with regard to your concerns. However I wanted to leave a brief reply welcoming you to NeuroTalk.:welcome_sign: Best wishes for your full recovery. :)

Appreciate that!

Hi Sawfish,

I am sorry to hear of your injury but glad it isn't worse. You seem well apprised of nerve injury issues but an extra resource if you need it is...

http://nerve.wustle.edu

This is the program at Washington University and is home to Dr. Susan Mackinnon who is one of the biggies in peripheral nerve surgery. She leads breakthrough research and trains the next generation of peripheral nerve surgeons.

It never hurts to get information. Many hand surgeons will be savvy of nerve issues but finding one who has done a peripheral nerve fellowship is even better. At most a consult could identify problems or a treatment plan and at least could ease your mind. Some nerve specialists will do a "Scratch Collapse test" to check for injury and they can use this to monitor progress. You can find Youtube video of Dr. Mackinnon doing them.

From personal experience I can say that nerves are really sensitive to compression and it can be difficult to tease out what's going on. I had a partial transection and traumatic neuroma on a tibial branch that required a 3.5 hour repair. My surgery was successful and life changing (pain was off the charts) but I did have lingering symptoms for a long time due to compression from swelling and scar tissue. I had my surgery done by a plastic reconstructive surgeon who completed a fellowship at Washington U. I'm not saying you need surgery by any means. Just recommending the best sub-specialty to evaluate.

I also found help with a Physical Medicine and Rehabilitation doctor who does ultrasound of peripheral nerves. He noted the presence of scar compression post-op and actually did guided cortisone injections to diminish it without having to go back in surgically. Explore your options.

I suspect that bruising is not helping things. That alone could be enough pressure to cause symptoms. It is a tight area in there and it may be hard to evaluate until that is resolved. But again, if it eases your mind go ahead and initiate a consult.

I hope you find complete healing soon, :hug:

Thanks, Littlepaw, I will check out Dr. Mackinnon. As long as it doesn't get worse, I guess I will give the hematoma (lump) time to resolve. I know that can take a while, and it's only been a couple of weeks. Glad your surgery worked out.