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Nerve repair
This surgery repairs a cut or divided nerve in the hand, wrist or forearm, reconnecting the nerve so that sensation and movement can recover.
At a glance
Anaesthetic
General anaesthetic
Where
The Avenue Hospital
Day case or overnight
Usually day case - home the same day, unless other injuries need a longer admission
First post operative review
One week after surgery
Driving
Not until out of your splint or dressing and you have adequate hand function and control
Post Operative Hand Therapy
Required for splinting, sensory re-education and rehabilitation
Splinting
Yes - a protective splint is usually worn for around 3 to 4 weeks to protect the repair while it heals
Pain relief
Usually paracetamol and/or ibuprofen; stronger pain relief may be needed for the first few days
Return to repetitive & heavy loading
Varies with the nerve repaired and your job; often 6 to 12 weeks, guided by your hand therapist
Repair of a cut or divided nerve
Nerve repair reconnects the two ends of a divided nerve. It is usually performed under magnification, using loupes or an operating microscope, to align the nerve’s internal fascicles as accurately as possible. Repair is generally carried out as soon as practical after the injury, as this gives the best chance of recovery. If the two nerve ends cannot be brought together without tension, a nerve graft or conduit is used to bridge the gap.
Who is this procedure for?
- A confirmed complete laceration of a nerve, causing numbness or weakness in the area it supplies
- A nerve injury found while exploring a wound for another reason, such as a tendon repair
- Select chronic nerve injuries, where a delayed repair, graft or nerve transfer may still help
What does the surgery involve?
An incision is made to expose the injured nerve. Both nerve ends are identified and prepared, then aligned and repaired with very fine sutures under magnification (loupes or an operating microscope). If the gap between the nerve ends is too large to repair directly without tension, a nerve graft – taken from elsewhere in the body – or a conduit is used to bridge it. The repair is protected afterwards with a splint and activity restrictions.
Alternatives to surgery
For a complete nerve laceration, there is generally no non-surgical alternative to restore the nerve’s continuity, as divided nerves cannot reconnect on their own. Depending on your situation, other considerations may include:
- Observation: appropriate for an injury where some recovery without surgery, is likely, such as a stretch or blunt injury
- Timing of repair: most nerve lacerations are repaired promptly, though a delayed repair, graft or nerve transfer is sometimes still an option for an old injury
What happens if left untreated: an unrepaired complete nerve injury leads to permanent loss of sensation, and for a motor nerve, permanent muscle weakness, in the area it supplied.
Dr Tomlinson will discuss which options suit your specific injury at your consultation.
Frequently Asked Questions
Where will my surgery be done?
At The Avenue Hospital.
How much time will I need to have away from work?
This depends on what your job involves. If your work is desk-based, you may return within a week or two with your hand splinted. If your job is manual or involves repetitive use of the hand, you will usually need longer, guided by your hand therapist.
When will I be able to drive again?
Not until you are out of your splint or dressing and have enough hand function and control to drive safely.
When can I do a full day of administrative or desk work?
Often from 1-2 weeks after surgery, particularly with some workplace modifications, provided the splinted hand is not required for typing or heavy use.
What workplace modifications might help?
Depending on your job, helpful temporary modifications can include voice-to-text software, a modified keyboard or mouse set up for one-handed use, or reassigning tasks that need two hands.
I take a GLP-1 medication (such as Ozempic, Wegovy, Mounjaro or Trulicity) — how does this affect my procedure?
GLP-1 medications, used for diabetes or weight management, slow the emptying of the stomach. This can increase the risk of stomach contents being present during a general anaesthetic. In line with current ANZCA guidance, if you’re having a general anaesthetic you’ll be asked to follow a clear-fluid-only diet for 24 hours before your procedure, followed by the standard 6-hour fast. Please tell us and your anaesthetist that you take this medication — your anaesthetist will give you specific instructions.
How long will I need to wear a splint?
A protective splint is usually worn for around 3 to 4 weeks to protect the repair while the nerve ends heal together.
Will I need to see a hand therapist afterwards?
Yes. A hand therapist supports splinting, protected movement, and sensory re-education as the nerve regrows.
What pain medication will I need afterwards?
Usually simple pain relief – paracetamol and ibuprofen – is enough. Stronger pain relief can be prescribed for the first few days if needed.
Risks & complications
General risks of hand surgery
- Bleeding and bruising; rarely, a collection of blood (haematoma) that may need draining
- Infection, which may require antibiotics or, rarely, further surgery
- Pain — usually temporary, occasionally persistent
- Swelling – common, and usually settles over weeks to months
- Scarring – scars are permanent and occasionally become thickened, raised or sensitive
- Allergic reaction to the local anaesthetic, antiseptic, dressings, tape or suture material
- Delayed or problematic wound healing
- Stiffness or reduced movement in the fingers, hand or wrist
- Injury to nerves, causing numbness, altered sensation or, rarely, a painful neuroma
- Injury to blood vessels (arteries)
- Injury to tendons
- Injury to bone (fracture)
- Failure to fully relieve your symptoms, or symptoms returning over time (recurrence)
- Complex regional pain syndrome (CRPS) – an uncommon but significant condition causing ongoing pain, stiffness and swelling
- Cold intolerance – the hand becoming more sensitive to cold, usually improving with time
- The need for further surgery
- Blood clots in the leg or lung (DVT/PE) – uncommon in hand surgery, with a slightly higher risk after a general anaesthetic or prolonged immobilisation
Specific risks of this surgery
- Incomplete or absent recovery of sensation or movement despite a technically successful repair, as nerve regrowth is unpredictable
- Altered or painful sensation at the repair site, including a tender neuroma
- Ongoing numbness or weakness in the area the nerve supplies
- The possibility of needing a nerve graft if the gap between the nerve ends is larger than expected at surgery
Anaesthetic
Your anaesthetist will discuss the specific risks of anaesthesia with you separately.
Recovery & rehabilitation
First 48 hours
Keep your hand elevated for 48 hours to reduce bleeding and swelling
First week
Keep the splint and dressing dry and intact. You may use your hand gently for light tasks outside the splint as directed
Second week
The splint continues to protect the repair. Gentle protected movement may begin as directed by your hand therapist
6 weeks
Your splint is usually able to be reduced or removed. Nerve regrowth is slow — roughly 1mm a day — so recovery of sensation and movement continues well beyond this point
3 months
Early signs of sensory return may start to appear, depending on the distance between the repair and the area the nerve supplies
Long term
Nerve recovery can continue for 12 to 18 months or longer. The eventual extent varies between patients and depends on the nerve injured and the distance from the repair to its target
Want to know more about nerve repair?
Contact us to schedule an appointment with Dr Tomlinson.
Fees and costs
You will receive a written financial quotation after your consultation, once your operation and any third-party requirements are confirmed. See our Fees and informed financial consent page for how our fees work, what your quotation includes, and the resources available to you.