Case 26 – Severe Peripheral Nerve Loss With Gradual Sensory Re-Engagement

A male client in his mid-50s presented with severe bilateral hand pain, loss of finger sensation, and progressive upper-body dysfunction. He had been working three physically demanding jobs for many years, often going without sleep for several days at a time.

Graded neuromuscular retraining following severe peripheral nerve damage, focusing on restoring hand function and sensory integration beyond initial surgical outcomes.

In the previous year, he developed intense burning pain across both palms and forearms, described as a “fire-like” sensation. He was assessed as having spinal nerve involvement but did not receive timely intervention. Subsequent neurological testing revealed severe peripheral nerve damage due to long-standing, untreated carpal tunnel syndrome. Despite bilateral hand surgery reducing the burning pain, full finger sensation was deemed permanently lost.

Functionally, he relied heavily on visual input to grip objects, requiring extreme concentration to briefly hold a pen. From early this year, he also developed severe right-sided chest, thoracic, and lumbar pain, with sharp pain triggered by arm elevation.

Assessment identified significant spinal neural involvement, markedly reduced spinal joint mobility, widespread inflammation, extremely low hand temperature, and complete absence of tactile feedback in the fingers. Treatment initially focused on spinal neural regulation, shoulder and rotator cuff mobility, and respiratory muscle function to restore upper-body movement capacity.

As shoulder mobility improved, hand temperature increased, allowing progression into graded neuromuscular retraining. Training began with visually guided gripping tasks, advancing to reduced visual reliance and eventually eyes-closed object manipulation. Over time, he regained the ability to stabilise grip on objects of varying size and movement patterns. Notably, subtle sensory changes began to emerge in the fingers, described as faint tingling—an unexpected outcome given the prior neurological prognosis of permanent sensory loss.

Clinical Practice: Heal Young Massage

Evidence-based remedial massage and movement rehabilitation services.