Peripheral Nerve Injuries

Diagnosis

The diagnosis of peripheral nerve injury involves talking about the symptoms, medical history, and accidents, performing a neurological and physical evaluation, and requiring several tests.

Tests that may be ordered include:

• Magnetic resonance imaging (MRI):  Detailed images of the locations where nerve damage has occurred can be shown through this test. MRI uses magnetic field and radio waves to generate comprehensive images.
• Ultrasound: Precise images of the nerve injury affected area is generated using high-frequency sound waves. This provides valuable information about the extent and location of the damage, aiding in diagnosis and treatment planning.
• Electromyography (EMG): The weakening of muscles detected during an EMG may be a sign of nerve damage. During the procedure, an electrode with a tiny needle is introduced into the muscle to record electrical activity in the muscle both during rest and during movement.
• Nerve conduction study: The body’s ability to conduct electrical signals through nerves is measured by electrodes positioned at two distinct sites.

Treatment

When a nerve is injured but not fully severed, there’s a higher likelihood of healing. Complete severance of a nerve presents a significant challenge in treatment, and sometimes recovery may not be fully possible. The treatment approach is determined by the injury’s extent, cause, and the nerve’s healing progress.

Non-Surgical Treatments

If the nerve shows signs of proper healing, surgery might not be necessary. The key strategies include:

• Rest: It’s crucial to allow the affected area to heal by avoiding activities that might stress the injured nerve.
• Medication: Pain relief may be managed with over-the-counter options like aspirin or ibuprofen. For nerve pain, medications typically prescribed for depression, seizures, or insomnia might be used. Corticosteroid injections are also an option for pain management.
• Physical therapy: To avoid stiffness and regain function, physical therapy might be recommended.
• Regular checkups: Monitoring recovery through regular medical checkups ensures that healing is on the right track.
• Treatment of underlying conditions: If a medical condition has caused the nerve injury, treating that condition is a priority.

Surgical Interventions

Surgery may be considered if the nerve isn’t healing as expected:

• Electromyography (EMG) testing: Intraoperative EMG testing can assess nerve recovery more accurately than external tests.
• Decompression: Surgery might be performed to enlarge spaces that are too tight or to release the nerve from scarring.
• Nerve repair or graft: Severely damaged sections of nerves may be removed and healthy ends reconnected, or a nerve graft from another body part may be used to encourage nerve regrowth.
• Tendon transfer: For severe injuries, surgery might be needed to restore critical muscle function by transferring tendons.

Restoring Function

Several treatments aim to restore function to affected muscles:

• Braces/splints: These devices help maintain proper positioning of limbs to improve muscle function.
• Electrical stimulation: This method activates muscles served by the injured nerve during the regrowth period, although it might not work for everyone.
• Physical therapy: Specific exercises and movements keep affected muscles and joints active, preventing stiffness and aiding in the restoration of function and sensation.
• Exercise: Regular exercise can strengthen muscles, maintain range of motion, and reduce cramps.