Digital Nerve Injury
Conditions
Keywords
digital nerve injury, digital nerve lesion, randomised controlled study, surgical nerve repair, non-operative treatment
Brief summary
Nerve injury in the fingers is a common injury and affects people of all ages. The treatment usually offered to patients is surgery and various types of rehabilitation. There is a lack of knowledge and research on how these injuries should be treated in the best way and how well sensory function can be restored after an injury. In this research project, we will investigate results after treatment for digital nerve injuries by entailing a randomised controlled trial allocating patients with isolated digital nerve injuries to either surgical repair or non-operative treatment in a cast. Primary outcome is digital nerve function as measured by 2-points discrimination at 1 year after treatment. Secondary outcomes include finger mobility, dexterity, handfunction, occurence of pain and anxiety and time on sick leave.
Detailed description
Patients over the age of 20 with an acute traumatic isolated digital nerve injury to any of the fingers and not in the thumb will be investigated for inclusion in the study. After informed written consent a sealed envelope randomisation will allocate patients to treatment with either surgical exposure and epineural suture or non-operative treatment in a cast. Due to the nature of treatment arms the allocation will not be blinded. Clinical follow-up and investigation of primary and secondary outcomes will be conducted at 3 weeks, 3 months, 6 months and 1 year after inclusion.
Interventions
PROCEDUREEpineural suture
2 or three sutures
PROCEDURENon-operative treatment
The injured finger is protected in a plaster cast
Sponsors
Karolinska Institutet
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
NONE
Intervention model description
1:1 randmoised controlled study
Eligibility
Sex/Gender
ALL
Age
20 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Clinical signs of isolated traumatic digital nerve injury in digits 2, 3, 4 or 5. * Patient age =\> 20 years on day of injury. * Injury location on volar aspect of finger. * Acute sensory dysfunction in suspected digital nerve injury area.
Exclusion criteria
* Digital nerve injury ot the thumb * Digital nerve injury in the palm of the hand (i e proximal to the finger base) * Patient does not speak or read the Swedish language. * Abusive drug or alcohol use * Dementia. * Injury mor than 7 days at dianosis AND/OR operative treatment cannot be offered within 10 days from injury. * Neurologic disease. * Ongoing infektion in the injured finger. * concomittant tendoninjury or fracture in injured or adjacent finger. * Injury mechanism is of blunt or crush charachter
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Static two points discrimination (S2PD) | one year after injury | a static two points discrimination test performed by an occupational therapist of the injured finger |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Ratio between S2PD in injured finger and S2PD in uninjured contralateral finger | 3 and 6 months and 1 year | Ratio between S2PD in injured finger and S2PD in uninjured contralateral finger |
| Semmes-Weinstein monofilament test | 3 and 6 months and 1 year | Discriminatory sensory function as measured by Semmes-Weinstein monofilament test |
| Mini Sollerman test | 3 and 6 months and 1 year | Hand function as measured by the Mini Sollerman test |
| Grip strength | 3 and 6 months and 1 year | Grip strength of injured and non-injured hand as measured by Jamar dynamometer |
| Quick-DASH | 3 and 6 months and 1 year | Patient Rated Outcome measure (PROM) for hand function as measured by the quick-DASH (Disability of the Arm, Shoulder and Hand). 11 items with 5-level Likert scales measures upper limb function. The scale ranges from 0 - 100 and 0 is the lowest possible disability. |
| HQ-8 | 3 and 6 months and 1 year | Patient Rated Outcome measure (PROM) for hand function as measured by the HQ-8 (Eight item HAKIR questionnaire) |
| Active range of motion | 3 and 6 months and 1 year | Range of motion of the injured finger (sum of MCP + PIP + DIP joint motion measured in degrees) |
| Anxiety and depression | at inclusion | Psychologic wellbeing as measured by Hospital Anxiety and Depression scale (HAD) (PCS) |
| Pain catastrophising scale, (PCS) | at inclusion | Pain catastrophising scale, (PCS) measures 13 items on a 5 points Likert scale. Higher scores represent high degree of pain catastrophising scale, (PCS). |
| Sick leave time | 1 year | Days of absence from work |
| Wait for surgery | 3 weeks | The number of days that have passed from the day of injury to the day of surgery are reported |
| Time in operating theatre | day of surgery | Time in operating theatre is measured in minutes |
| Neuropathic pain | 3 and 6 months and 1 year | Occurrence of neuropathic pain as measured by Doleur Neuropathic 4 questions (DN4). 4 aspects of neuropathic pain are evaluated by 10 questions, with higher scores representing a worse state. |
Countries
Sweden
Contacts
Primary ContactCarin Carlsson, MD
Backup ContactCecilia Mellstrand Navarro, MD, PhD
Outcome results
None listed