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Duke Orthopaedics
presents
Wheeless' Textbook of Orthopaedics

Nerve Injury


- See: EMG

- Nerve Injury Discussion:
    - remember that in any case of presumed nerve injury, always consider whether an isolated compartment syndrome had occured;
    - neuropraxia:
         - least severe injury, is characterized by a conduction block (focal conduction block);
         - conduction across the zone of nerve injury is inhibited, however, conduction within the nerve both proximal and distal to the lesion remains intact;
         - continuity of all structures is preserved;
         - Wallerian degeneration does not occur (no axonal loss)  but there is focal demyelination;
         - complete recovery is evident in 3 to 6 weeks;
         - after a simple crush injury function may return within days;
         - w/ neuropraxia there is immediate conduction block across the site of injury with normal conduction distally;
         - with severe trauma, there is focal demyelination w/o disruption of axons, and slowing of the conduction velocity can be demonstrated across the lesion;
         - conduction block is restored once myelin regeneration is restored (taking weeks to months);
    - axonotmesis:
         - is more severe injury, with disruption of axons & surrounding endoneurial sheaths;
         - perineurium and epineurimum remain intact;
         - Wallerian degeneration occurs;
         - after axonotmesis, conduction velocity may be preserved distally for up to 7 days;
         - recovery is good but may require many months;
    - neurotmesis:
         - Wallerian degeneration occurs;

- Complications:
    - reflex sympathetic dystrophy
    - neuroma


Erythropoietin Accelerates Functional Recovery After Peripheral Nerve Injury

Pain relief after nerve resection for post traumatic neuralgia.    

Treatment of superficial and deep peroneal neuromas by resection and translocation of nerves into the anterolateral compartment.

Treatment of the painful neuroma by neuroma resection and muscle implantation.  

Neuroma transposition and intramuscular implantation using the Mitek "soft-tissue anchor": a new technique.



Original Text by Clifford R. Wheeless, III, MD.

Last updated by Data Trace Staff on Thursday, May 24, 2012 10:56 am