Hand Wound (Medical Question)

Factual Questions
1

Last Friday, my wife was wrestling with a stubborn milk bottle cap that wouldn’t come off. She attempted to pry it off by using a table-knife as a lever. Bad move, as the knife slipped, slicing open her left index finger at the base. The cut was about 1 1/2 inches long, and about 1/4 inch deep at the deepest part, which is the part that faces her thumb.

Some EMS guys came around. They were insistent that we not allow an emergency room doctor to stitch it up, and that we insist instead on getting a hand surgeon, to assure that there was no lingering internal damage. But the first couple of hand surgeons that we contacted were out of town and the third did all their stitching at the ER, so we showed up there intending to request that the hand surgeons be summoned.

But the ER nurse insisted that there was no need for a hand surgeon. This because my wife was capable of normal motion, indicating that their was no ligament or tendon damage So too did the ER physician. Furthermore, the hand surgeons were not on call, which meant that had we insisted on using them we would have a wait of possibly several hours. We called my wife’s regular doctor, who was also inclined to think that if she had the capability for regular motion we could let the ER doc stitch it up. This was also the opinion of the local ER surgeon who we asked about it. So we let the ER doc stitch it up.

Over the weekend my wife noticed that the numbness in that finger was not subsiding. We got a little concerned. Than I ran into my brother-in-law who said that the ability to use your fingers is no indication that nerves have not been severed. He says that some years back he had a similar incident, and after not regaining feeling for a month (though he had a full capability for motion) he had to have a hand surgeon reopen the hand and reconnect the nerves. OTOH, my sister’s friend had a cut which left her numb for several months, but she eventually recovered full sensation on her own.

We were concerned, and my wife was a bit worried about the fact that the swelling did not seem to be going down, so she visited her regular doc (the partner of the guy we spoke to last week) on Tuesday night. He said yeah some nerves must have been cut, but there’s nothing a hand surgeon could have done for you anyway, or can do for you now. You just have to hope it gets better.

By contrast, our kid’s pediatrician (who I hold in higher regard as a doctor) says she should have a hand surgeon take out the stitches and inspect it then.

At this point, she can feel pressure but not any other sensation in the affected area (mostly the part of the finger that is directly beyond the deepest area of the cut until the tip), and is completely oblivious to heat and cold. She thinks it is possible that the affected area is shrinking a bit but isn’t sure. (Its difficult in general to sort out the nerve issues from the issues of swelling and pain.)

So the questions are:

  1. Do we need to get to see a hand surgeon at all? (This is not as simple as it sounds, as it will involve researching hand surgeons, getting referrals, and possibly traveling to a more distant location).

  2. If we do, how much is time a factor. IOW, can we always wait to see what happens or will it be too difficult by that time? (My BIL says the longer you wait the more chance you have that scar tissue will build up and cause problems).

  3. How is it possible that on what seems like a routine medical matter there should be such a divergence of opinion among reasonably qualified medical people? (When we were at the ER not a single person brought up the issue of nerves at all, and the first I heard of it was from my BIL, several days later.)

I would appreciate hearing from anyone with medical background, or from anyone who has been in a similar situation themselves. But general comments from the wise masses are also welcome, as always.

This was a bit longer than I thought it would be. I hope people can read all the way through it. :slight_smile:

2

It’s impossible for me to judge competently, not having examined the wound, but on general principles I can state that any such cut will sever peripheral nerves, and leave surrounding areas numb. In most cases, these nerves are not repaired by microsurgeons as they are too small, and things are left to heal on their own, with variable results. Offhand, (no pun intended) it doesn’t sound like a hand surgeon would have done much different. I had hoped to bounce this off one of my good friends, a bonafide hand surgeon, but dammit, he’s in surgery this morning.

Qadgop, MD

3

Anyone with medical training who actually saw the wound can probably give you better advice than anyone sitting at a computer somewhere reading your description but, here goes: From your description of the wound and symptoms and based on what you say the people who actually saw the wound said, I doubt that seeing a hand surgeon would make any difference. It doesn’t sound like your wife severed a nerve big enough to repair. But even though seeing a hand surgeon is unlikely to benefit the hand and even though it will cost a bundle, you might still benefit if the peace of mind is important enough to you. That’s an individual decision.

4

God. This is the THIRD time I’m trying to respond to this thread. Freaking ISP. <sigh>. Anyway, best healing thoughts to Mrs. Izzy first of all.

How can there be such diverging opinions? There are in every single career. The problem is that for most intelligent people, you want to find the best solution and treatment, not just the easiest or cheapest. It’s not a used car, it’s her body- and her HAND !!

The ER people are there to deal with trauma, then medical problems. Dr. Futzlebuggy is no doubt a good stitcher, but he’s no microsurgeon. In his professional estimate, the nerves will more or less rejoin in a while and she’ll have a scar. In the rapid treatment world of an ER, that’s a very good outcome. Professional and thorough- I’m not slamming Dr. Futzlebuggy at all for it.

HOWEVER- it’s not the best or most acceptable outcome to you and the diving Mrs. Personally, I’d have asked them to bandage the wound without stitching and hie on over to a hand surgeon, even if it meant a day or two with an unsutured wound. Butterfly bandages and good antibiotics would have kept it okay. Now, you have to have a hand surgeon re-open the wound ( Qadgop- which is preferable? Leaving it open till the hand surgeon can tend it, or having to re-open stitches?? ).

When my friend’s young daughter was bitten in the face by a dog a few years ago, and I drove them to the hospital in the ambulance, the ER Dr’s wisely did not even attempt to clean up the blood. That’s right. They left her looking awful and messy. They knew that the plastic surgeon would only have to REMOVE any dressings and in doing so, remove even more viable material. They actually kept the lacerations wet with sterile water, so that they wouldn’t start to dry out. ( It was a holiday,and the plastic surgeon was in the OR with an other emergency…she was not treated for approximately 8 hours ). She has a lot of scarring, but no loss of facial nerves.

The problem ( to get back to the quote above ) is that you put your faith in the person standing before you. I very VERY rarely get such a bad feeling about a Dr. that I literally don’t listen to what they have to say. I’ve had to deal with a shitload of them recently, and every single one was stellar. They just each had their own take. So, I have to do research and make a balanced choice. I’m not taking any pot shots at Dr’s here, it’s just that each person will believe with ABSOLUTE certainty that their method of treatment is the most appropriate. I’ve offered you some scenarios, doubtless others here will too. Might help. The best thing to do, I’d say, is to talk to more than one hand surgeon as soon as you possibly can. Keep copies of all records and Xrays and MRI’s taken. ( You can get that ER’s Radiology Dept. to strike copies for a few dollars per copy). That will save you days and days of wait time. The less scar formation time that hand has, the better off she’ll be.

Good luck. Sounds like all things being equal, she got off kind of lucky.

Cartooniverse

(edited to fix format error - Jill)

[Edited by JillGat on 04-20-2001 at 08:11 PM]

5

Coming up on 1,000 posts and I still don’t Preview every time? Sorry about that. Coulda sworn I coded that correctly.

6

OK, talked to my friend the Hand Surgeon. He sez that as long as a major nerve is not severed, specifically in this type of case the one ennervating the far tip and pad of the finger, he wouldn’t be inclined to attempt any nerve repair. So if the pad of the digit past the furthest joint has feeling, he probably wouldn’t have insisted on coming in to do the repair, unless he personally needed the income. If the fingertip was numb, then he’d have felt it was necessary for a microsurgeon to evaluate. Now remember this is before they inject the anesthetic that it would have to be numb.

Hope that helps,
Qadgop, MD

7

Spoken in a muttering voice as Cartooniverse sullenly polishes the leaping feline on Qadgop’s Jaguar

Hard to get good help these days, ain’t it? :stuck_out_tongue:

Cartooniverse

8

I did something really stupid a few months ago, and cut my thumb deeply. Now, I can touch part of it and it’s numb, and I can touch another part, and it feels like I’m touching it somewhere else. My question is, will my brain ever get used to stuff being moved, and start realizing that I’m touching it here, and not there? A potential career in safecracking could lie in the balance.

9

I think that sort of “test” to see if there’s nerve damage- wiggling your fingers- is probably common procedure. I know that’s how they decided I didn’t do any major damage to my hand when I accidentally cut open the base of my thumb with a box-cutter (which I can no longer look at, never mind touch- eleven years later!) the cut was probably deeper than 1/4 of an inch, given the internal stitches, but fortunately my hand is none the worse for it other than the unsightly scars from the cut and every stitch…

10

Firstly, I’d like to thank everyone who responded to this thread. One of the great things about the SDMB is that there are intellignet people who actually know what they are talking about who can shed light on thorny issues. It was startling to find myself in a situation with such a lack of medical consensus, as mentioned. But having gotten there, it’s great to have the SDMB experts available.

Anyway, due to the continuing uncertainty, and the potential long-term consequences, she went to a hand surgeon yesterday. (We found a guy about 1 1/2 hours away who is alleged to be one of the top hand surgeons in the country, and who is fortuitously on our insurance). This doctor performed all manner of tests with all sorts of machinery. He said she had definitely severed a major nerve, and probably nicked a tendon as well. He said you could leave it alone and the nerve might or might not heal over the next 9-12 months. If it didn’t it would be impossible to repair, as the nerve endings would recede (after 3 weeks). Also, she would probably develop a neuroma (sp?) which was a nerve bunching resulting from the nerve’s attempt to heal itself. This would cause pain under some circumstances, and also false sensory signals to brain (presumably the feelings described by excitableboy). The tendon, if it was indeed damaged, would not heal itself.

So she had the surgery the next day (today). The tendon had indeed been cut, and was repaired. He reattached several nerve endings. Also a neuroma was removed. Long term results are not available, of course.

In conclusion, it goes to show that you never can know for certain, and always get a second opinion, as Cartooniverse noted. Who knows how many people in identical situations don’t bother getting a second opinion, and suffer the consequences for life?

Anyway, thanks again to all who responded.