General Surgery - Digital Nerve Injury

What is a digital nerve?

• There are digital nerves in each of your fingers and thumb
• They are on the palm side of the hand and are located on each side of the finger
• These nerves tell your brain when something is hot, cold, sharp, hard etc
• A nerve has two layers: the outer layer protects multiple thin inner nerve fibres. These inner fibres are the wires that carry messages back and forth to the brain

What happens when a nerve is injured?

Your nerve can be injured in different ways which would range from bruising/stretching of nerve to the division of nerve fibres.

In bruising type of injury, the nerve will stop working for a short period of time, but it will recover fully within a period of days to weeks and leaves no deficit. Whereas if the nerve is completely divided, which may occur when you have cut your finger or palm, usually requires an operation and for the nerve to be repair for it to recover.

What are the symptoms and signs of a nerve injury?

• Loss or alteration of sensation – when the surgeon tests your sensation, there may be varying degrees of loss of feeling
• Pain – this is variable in its intensity
• Dryness of the skin due to loss of normal sweating
• Increased sensitivity to cold
• If the nerve injury is old, there may be changes such as thinning of the pulp of the fingers, loss of normal skin creases over joints and an electric shock like sensation when tapping along the course of the nerve

What does the operation involve?

If there is a wound, it is best to explore the wound and repair the nerve if there is an injury. This is most often done with a local anaesthetic to numb the finger.

The surgeon will make the wound slightly bigger to find the two ends of the nerve and repair this using a very fine suture

You will then be placed in a bulky bandage to protect the repair and be seen by the therapists in a week’s time to start an exercise regime.

If the nerve is not repaired, it will not recover and may form a painful lump called a neuroma.

What is the outcome after nerve repair?

Nerves take many months to repair themselves and for the nerve fibres to reach the fingertip. Nerves grow back at around 1mm per day.

This means the finger is likely to remain numb for quite some time after the operation. The result may not be known for two years or more.

In this time, you may experience pins and needles, tingling or electric shock shooting pains. This is normal after a nerve repair.

What do I need to look out for after surgery?

If you get any of the following symptoms, please seek medical help either by calling our dressing clinic within hours (8.30am - 4pm) or by attending the Emergency Department

• Pain lasting more than 6 weeks
• Redness and warmth of the finger that is spreading or an unpleasant smell of yellow discharge from the dressing – this can indicate an infection

Scar massage and desensitisation

Once the wound has healed, it is important to start massaging the scar and introducing it to touch.

• Firmly massage the scar in circular movements using deep and firm pressure. This allows the structures under your skin to move freely and for the scar to not stick to the underlying surface
• Touching, tapping and exposing the scar to different textures can help normalise the sensation as the numbness recovers

Please be aware that while you have a lack of sensation to the hand, you need to be very careful when handling sharp or hot objects.