Peripheral Nerve Injuries
The hand and upper extremity are innervated by three major peripheral nerves: the median nerve, ulnar nerve, and radial nerve. Injury to any of these — through laceration, crush, stretch, or compression — can result in loss of sensation, motor function, or both. The degree of recovery depends critically on injury level, mechanism, time elapsed before repair, and surgical technique.
Surgical Options
Primary Nerve Repair
When a nerve is sharply divided, direct end-to-end repair under magnification is performed as soon as possible. Dr. Richards performs microsurgical nerve repair, meticulously aligning nerve fascicles under the operating microscope.
Nerve Grafting
When a gap between nerve ends cannot be bridged without tension, a nerve graft is required. Donor nerves (typically sural nerve or medial antebrachial cutaneous nerve) provide a scaffold for regeneration across the gap.
Nerve Transfers
In complex proximal injuries, nerve transfers use expendable nearby nerves to repower critical muscles — an area of rapid evolution in hand surgery that Dr. Richards follows closely.
What to Expect
Nerve regeneration is slow — approximately 1 mm per day. Recovery after nerve repair requires patience and dedicated hand therapy. Realistic expectation-setting is a critical part of Dr. Richards' approach.