Nina Sunder tried to force the snug plastic cap off an X-Acto® knife. It just wouldn't budge.
"With brute force, I pulled the top back so hard that I stuck the knife straight into my right index finger," says Sunder, a 40-year-old stay-at-home mom from Allentown. "I was screaming. Blood was pouring out."
Her husband rushed her to ExpressCARE at Lehigh Valley Health Network (LVHN)–Tilghman in west Allentown. Stopping the blood was as simple as gluing the cut shut. But Sunder's entire finger had gone numb. "I expected to feel pain," she says, "but I could not feel my finger at all."
Cut to the nerve
Concerned, Sunder met with LVHN orthopedic surgeon Richard Battista, MD, with OAA Orthopaedic Specialists. He told her she'd cut a nerve and would need nerve repair surgery in order to return sensation and function to her finger. "Untreated, the severed nerve and scar tissue would have left her with lasting – if not permanent – numbness," Battista says. She could neither bend nor straighten her finger, so it remained stiff and curled.
While it may seem minor, a badly cut finger can seriously impact daily life. Without the use of an index finger on her dominant hand, Sunder struggled to hold a fork or spoon. She couldn't use a knife to slice the food on her plate. She couldn't write with a pen or make a fist. Turning the key in her car ignition was such a challenge that she resorted to reaching over and doing it with her left hand.
Precise surgical treatment
Nerve repair surgery is effective and requires great precision. "Nerves are difficult to re-pin," Battista says. "This is especially true in the fingers, where a nerve is about the size of a string of spaghetti, and each string is composed of thousands of nerve fibers that are finer than a strand of human hair." Sewing two finger nerves back together is challenging because the nerve fibers need to line up in order to restore function to the hand.
You're more likely to have a good result from nerve-pinning surgery if you're younger and healthier, and if you treat the nerve damage sooner rather than later.
Thankfully, Sunder sought help right away, and Battista was able to reconnect the fine nerve fibers in her index finger.
From repair to re-use
After surgery at LVHN–Tilghman, Sunder saw the outpatient hand therapy team at 250 Cetronia Road in Allentown twice weekly. Her therapy started with ultrasound, massage and stretching to break up scar tissue and restore range of motion.
"At first, she was afraid of feeling pain, so she held her finger in an extended position all the time," says occupational therapist and certified hand therapist Betsy Green. "That compounded the stiffness. After a while, if you don't use a finger, the brain loses its connection with it. You forget how to use it."
To help Sunder, the team used a simple exercise, having Sunder gently rub a cotton ball against her finger. Once Sunder got used to that sensation, they suggested progressively coarser textures such as a bath towel and denim.
During therapy, Green and other hand therapists taught Sunder stretches and hand exercises, such as picking up small objects. Eventually they had Sunder pinching clothespins and molding putty. "My hand therapists were incredibly patient with me," Sunder says. "They pushed me, but in a good way, talking me through everything."
One day, roughly four months into therapy, Sunder realized she'd turned a corner. She could wrap her finger around the handle of her exercise bike, rather than have the finger poking out. From there, other tasks came back.
"Initially I thought I would never get my finger back – and never be able to use it again," Sunder says. "I'm now able to do everything I was able to do before the injury, including using a knife."