Nerve injuries in the hand.

Nerve injuries of the hand are an important problem for the emergency physician because most are diagnosed in the emergency setting. Successful diagnosis and treatment are critical if the injured patient is to regain full hand function. Emergency department management relies on the knowledge of hand and forearm functional anatomy and techniques for diagnosing loss of nerve function. Once a nerve injury has been diagnosed, issues such as primary versus secondary repair must be discussed with the hand surgeon. The hand surgeon must consider whether to pursue an epineurial or fascicular repair and must use additional techniques for diagnosing return of nervous function. Lack of nerve regeneration, chronic paresthesias, neuromas, and sympathetic dystrophy can complicate the successful return of hand nerve function after injury.