Hand and upper extremity nerve and vascular injuries

Injuries to the hand, arm and shoulder area can damage the nerves and vascular system. These complex injuries require specialized care to preserve the functional use of your child’s upper limb.

About hand and upper extremity nerve and vascular injuries

Nerves play a vital function in kids’ everyday lives, stimulating their muscles and allowing them to detect sensations from the outside world. When nerves are pulled, torn or compressed (also known as nerve entrapment or a “pinched” nerve), it can affect the function of the hand and upper extremity. The brachial plexus is the network of nerves that run through the neck, shoulder, arm and hand. A child can damage this bundle of intertwined nerves near the neck/shoulder, hindering their ability to move their arm, or they might injure only a specific nerve:

• Radial nerve – This nerve runs through the backside of the arm and hand and can cause pain on the back of the hand and along the arm.
• Medial nerve – When compressed at the wrist, this nerve can cause carpal tunnel syndrome, which affects the hands.
• Ulnar nerve – When compressed, this nerve along the inner elbow can cause problems in the hand and wrist.

The vascular system is made up of the blood vessels that supply your child’s body with oxygen and nutrients. Some hand or upper extremity injuries can damage blood vessels, which can reduce blood flow and cause other problems.

Experts in hand and upper extremity nerve and vascular injuries

As the only comprehensive pediatric hand and upper extremity program in the state, Children’s Wisconsin provides expert care to kids and teens with a wide range of common and rare conditions affecting the shoulder, arm, elbow, wrist and hand. With our team’s specialized training, vast experience and deep knowledge of the unique challenges of children’s growing bodies, we can ensure the best possible outcomes for your child’s recovery after a nerve or vascular injury. Our child-centered environment and wraparound services are designed to support the whole family and provide comfort when your child is stressed and in pain. If your child has already been diagnosed at another center, we invite you to get a second opinion at Children’s Wisconsin.

What causes nerve and vascular injuries in the hand and upper extremity?

Kids’ nerves can get damaged during childbirth (known as newborn brachial plexus injuries), car accidents, sports collisions, severe lacerations (cuts) and other incidents that cause trauma to the hand or upper extremity. These injuries can also occur with fractures and dislocations. Although carpal tunnel syndrome is rare in children, it can sometimes develop from repetitive wrist movements, such as gymnastics, tennis and playing musical instruments.

Vascular injuries are rare in kids, but they can occur after blunt force trauma, when a foreign object pierces the skin, or after a complicated bone fracture damages the surrounding blood vessels.

Why are hand and upper extremity nerve and vascular injuries a concern?

These injuries can lead to serious, lifelong complications if not treated immediately. Nerve damage can become permanent and affect the functioning of a child’s limb. Severe bleeding from a vascular injury can lead to shock, a life-threatening emergency. If a vascular injury prevents blood flow from reaching an area of the body, such as the hand, it could lead to tissue death and (in rare cases) amputation.

What are the symptoms of nerve and vascular injuries?

Signs of a nerve injury may include:

• Extreme weakness
• Numbness or tingling
• Paralysis/unable to move affected area 

Symptoms of a vascular injury may include:

• Bleeding
• Reduced or absent pulse at wrist
• Loss of sensation or trouble moving the affected area
• Injured area (or nearby area, such as the hand) appears unusually pale or cool

How are hand and upper extremity nerve and vascular injuries diagnosed?

The physician will evaluate your child’s injury through a physical examination and imaging. At Children’s Wisconsin, we use imaging procedures that ensure your child is exposed to the smallest amount of radiation possible. Imaging procedures may include:

X-rays – Uses invisible electromagnetic energy beams to produce images of internal tissues, bones and organs onto film

Magnetic resonance imaging (MRI) – Uses a combination of large magnets, radio frequencies and a computer to produce detailed images of organs and structures within the body

Computed tomography scan (CT scan) – Uses a combination of X-rays and computer technology to produce detailed, cross-sectional images of the body, including the bones, muscles, fat and organs 

Treatment for hand and upper extremity nerve and vascular injuries

Treatment will vary depending on the type and severity of your child’s injury. Some minor nerve injuries will heal on their own, but for more severe cases, your child’s doctor might recommend:

Surgical repair – Surgery might be required to repair a badly torn or compressed nerve or damaged blood vessels. Our highly skilled pediatric hand surgeon will surgically repair nerve and vascular injuries in a precise and delicate manner to preserve your child’s movement and function in the future. Procedures could include nerve grafting (replacing a damaged nerve portion with a healthy nerve) or nerve transfers (connecting nearby working nerves to damaged areas to power the nerves and muscles). If a nerve is compressed, the surgeon will release the surrounding structures to open up the area around the nerve.

Hand therapy – Hand therapy is a critical part of the postsurgical and nonsurgical process to promote healing, increase range of motion and maximize functional use of your child’s hand/arm. Our certified hand therapist offers serial casting, custom splinting, paraffin wax treatments, scar massage and more.

Long-term outlook for hand and upper extremity nerve and vascular injuries

Many children with nerve and vascular injuries recover well, but these are complex injuries that require close monitoring. As children get older, they might require other procedures to improve the functioning of their hand or upper extremity.