Nerve damage in the forearm from crush injuries or cuts can lead to significant disability. But nerves do heal even if at a very slow rate. In fact, studies show that with nerve repair, improvement can continue up to five years after the surgery. The keys to best outcomes are age at the time of injury and time between injury and surgery. Younger patients who have surgery soon after the injury have the best results.
A recent study from Sweden has provided us with information on what happens 30 years after nerve injury and repair in childhood or adolescence. They followed 45 patients who had a complete (nerve cut clear through) nerve injury of the median and/or ulnar nerves in the forearm. They measured outcomes in terms of sensory and motor function, level of pain or discomfort, and impact on the patient’s life (education, work, recreation).
They found that children who were younger at the time of the injury and repair (younger than 12 years old) had significantly better results. Complete recovery occurred in 87 per cent of the younger children compared with only 67 per cent of the teens (12 or older). Which nerve was cut (median or ulnar) didn’t seem to matter; age was the main prognostic factor.
Surgery was done in all cases to either repair (stitch the two ends of the cut nerve together) or reconstruct (use a grafted nerve to help the two ends meet) the injured nerves. In some cases, reconstruction had to be done right from the start because of the extent of the damage. In other patients, enough time had passed (up to 15 months in some cases) that the two nerve endings had retracted (pulled away) enough that stretching the nerve ends to meet was no longer possible.
When nerve grafting (reconstruction) was done in both age groups, the younger children still had better results. That was true regardless of whether one nerve (either one) or both were injured. Fortunately, motor function was preserved in all the patients no matter what age they were or which nerve was injured.
Cold sensitivity wasn’t a big problem. A few patients still had less tolerance to cold. The older group was affected the most and they reported that this problem gradually got better over time. Hand size was not different among any of the participants. The older group also said the injury influenced their leisure activities and choice of career but not how far they went in school (high school versus college).
The authors concluded that children who sustain nerve injuries at a younger age have a better chance for full recovery and function. Which nerve was injured doesn’t seem to make a difference in long-term results. But when both nerves were cut, patients reported a greater impact on education and recreation.
The authors mention that today’s patients facing similar nerve injuries may have even better long-term results compared with children and teens treated 30 years ago. It is now recognized that associated injuries (e.g., tendons, arteries) must be repaired as well. Newer surgical techniques and tools may also aid in better outcomes.
We also now know that participation and motivation in the rehab process make a difference. And we have better strategies to help patients relearn sensory function based on new information about brain plasticity (ability of the brain to adapt and recover).
Your friendship and support for your neighbor and son will be a lasting gift. Reaching out without pressure for information or speculation about what might or might not happen is a wonderful idea.