Peripheral Nerve Injuries
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Peripheral nerves function as the communication lines between the brain, spinal cord, and the rest of the body, enabling sensations like cold feet and facilitating movements necessary for walking. These nerves consist of axons, which are fibers encased in protective tissue.
However, peripheral nerves are delicate and prone to injury. When these nerves are damaged, it can disrupt the brain’s ability to coordinate with muscles and organs, a condition known as peripheral neuropathy.
Prompt medical attention for any peripheral nerve damage is crucial. Seeking early medical intervention can help avoid further complications and irreversible harm.
Symptoms
The symptoms of peripheral nerve injury depend on the specific nerve fibers affected. Often, injuries to peripheral nerves impact various types of nerve fibers, leading to a diverse array of symptoms. These symptoms can vary in intensity from mild to severe and may significantly disrupt daily activities.
Possible symptoms for each type of nerve include:
- Autonomic nerves: Possible symptoms include excessive perspiration, blood pressure fluctuations, heat intolerance, and gastrointestinal problems. This cluster of neurons controls automatic processes like respiration, heart and thyroid function, and food digestion.
- Motor nerves: If these nerves are damaged, muscle weakness, painful cramps, and uncontrollable muscle twitching may be felt. These nerves control the muscles that are consciously used, like those for walking, talking, and grasping objects.
- Sensory nerves: Damage to these nerves can lead to symptoms such as numbness or tingling in the hands or feet, difficulty sensing pain or temperature changes, challenges with walking, maintaining balance with closed eyes, or buttoning clothes. These nerves transmit information about touch, temperature, and pain.
If any of the signs and symptoms persist, consult a healthcare provider for proper diagnosis and treatment, especially when there is weakness, tingling, numbness, or complete loss of sensation in a limb. Early diagnosis and treatment is vital to recovery.
Causes
Peripheral nerves are susceptible to damage from a range of sources, including narrowing of arteries, hormonal imbalances, physical trauma from accidents, falls, and sports injuries, as well as medical and autoimmune conditions. Specific medical issues such as diabetes, Guillain-Barre syndrome, and carpal tunnel syndrome, along with autoimmune diseases like lupus, rheumatoid arthritis, and Sjogren’s syndrome, can lead to peripheral nerve injuries. These injuries may manifest through stretching, compression, crushing, or severance of the nerves, impacting their function significantly.
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.
