A peripheral nerve injury occurs when any nerves in the body that are not in the brain or spinal cord are damaged. Peripheral nerve disorders are frequently a result of acute traumatic and chronic repetitive injury, but at times are caused by inheritable or acquired autoimmune disorders. Any injury to peripheral nerves, distort or interrupt the messages between the brain and the rest of the body.
Sunderland’s classification of nerve injury describes five degrees of injury:
Neuropraxia: This is the first degree, which involves a localized conduction block in the nerve with the nerve fibers responding to electrical stimuli proximal and distal to the lesion, but not across the injured segment. Axonal continuity is preserved, wallerian degeneration does not occur, and recovery is usually complete.
Axonotmesis: This refers to disruption of the axon into proximal and distal portions with interrupted axoplasmic flow. Wallerian degeneration occurs within 24 hours in the distal portion of the axon and to a slight degree in the proximal portion. The connective tissue elements remain intact, however, and the axon may regenerate at a rate of 1 mm/day to the original end organ with the potential for complete recovery.
Endoneurotmesis: The endoneurium and axon are destroyed, but the perineurium remains intact. Wallerian degeneration occurs. Axons may regenerate, but can be blocked by scar tissue. This will result in partial reinnervation. In addition, misdirection of fibers can occur with resultant synkinesis (abnormal mass movement of muscles which do not normally contract together) and incomplete recovery.
Perineurotmesis: In this type, only the epineurium remains intact, while the axon, endoneurium, and perineurium are disrupted. With this type of injury, wallerian degeneration occurs, and there is much greater chance for aberrant regeneration, synkinesis, and incomplete recovery.
Complete Disruption: Here, there is a complete disruption of neural continuity. Except in cases of complete transection, nerve injury is usually a combination of degrees of injury.
Peripheral nerve injuries can be classified into two categories:
In complete injuries of any peripheral nerve, all the nerve fibres in the injured section of nerve are damaged, causing total loss of muscle power and sensation below the level of the injury.
An incomplete nerve injury means that some of the nerve remains intact and, therefore, the chances of a full recovery being made are improved. In incomplete nerve lesions, some muscle power and sensation will be present below the level of the injury.
General Symptoms of peripheral nerve injuries:
These often start gradually, and then get worse. They include
A detailed neurologic examination will be performed to evaluate motor, sensory and autonomic loss.
Electromyogram (EMG or Electromyography)
This test measures how the muscles supplied by a specific nerve are working. An instrument records the electrical activity in the muscle at rest, and as the muscle is moved or contracted.
Magnetic Resonance Imaging (MRI)
This test uses magnetic waves to produce a detailed, three-dimensional view of the affected body area, including the nerve.
Nerve Conduction Study
Similar to electromyography, this test measures how well electrical signals are transmitted through the nerves.
Patients with nerve injuries may be treated at physioline at any stage: at the time of the injury; later, for evaluation and treatment; or for secondary treatment, where people have not recovered adequate function after previous treatment.
It is critically important that a person with a nerve injury receive medical care as soon as possible. Without timely, appropriate medical care (within nine to 12 months of the injury, preferably earlier), the injured nerves may no longer be repairable. Peripheral nerves have a remarkable ability to regenerate themselves.
The management of a peripheral nerve injury varies depending on the cause, type and degree of the nerve injury.
Physiotherapy is very important to promote the recovery of peripheral nerve injuries regardless of whether surgery is required.
Physioline provides specialized treatment programmes, functional electrical stimulation and bracing or splinting to:
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