eMedicine Specialties > Orthopedic Surgery > Trauma

Peripheral Nerve Injuries: Workup

Author: Christine B Novak, PT, MS, Clinical Coordinator, Division of Plastic and Reconstructive Surgery, Research Associate Professor, Department of Surgery, Division of Plastic and Reconstructive Surgery, Washington University School of Medicine
Coauthor(s): Susan E Mackinnon, MD, FRCSC, FACS, Program Director, Division of Plastic and Reconstructive Surgery, Shoenberg Professor and Chief, Department of Surgery, Division of Plastic and Reconstructive Surgery, Washington University School of Medicine; Mark E Baratz, MD, Professor, Department of Orthopaedics, Drexel University College of Medicine; Residency Director, Department of Orthopaedics, Allegheny General Hospital; Consulting Staff, Allegheny Orthopaedic Associates
Contributor Information and Disclosures

Updated: Aug 29, 2008

Workup

Laboratory Studies

  • No specific laboratory studies assist in the diagnosis of peripheral nerve injuries.

Imaging Studies

  • Imaging studies are appropriate in cases of suspected nerve tumors, although false-negative and false-positive findings are possible in MRI evaluation of nerve tumors.
  • Imaging studies are appropriate in cases of suspected brachial plexus avulsion injury to evaluate for avulsion of the nerve roots from the spinal cord.
  • CT myelography can be used to investigate for suspected brachial plexus avulsion injury.

Other Tests

  • Electrodiagnostic studies: These objective tests are useful in detecting nerve injury and/or nerve compression and in identifying early stages of recovery.
  • Electromyography
    • This test is performed at least 4 weeks following nerve injury.
    • Electromyography testing done prior to that time may yield false-negative findings because it takes 4-6 weeks for muscle fibrillations to become apparent.
    • Evidence of denervation is indicated by the presence of fibrillations in the muscle.
    • Reinnervation is noted by the presence of motor unit potentials.
  • Nerve conduction studies
    • These studies are particularly useful in determining secondary compression sites that may be present. If the nerve is compressed at an entrapment site, such as the carpal tunnel or cubital tunnel, axonal regeneration may be impeded and thus limit reinnervation.
    • In cases of brachial plexus injury, nerve conduction studies can help to determine the presence of an avulsion injury. Intact normal distal sensory nerve conduction and motor denervation are diagnostic of an avulsion injury.

Histologic Findings

No specific histology studies assist in the diagnosis of patients with peripheral nerve injuries.

More on Peripheral Nerve Injuries

Overview: Peripheral Nerve Injuries
Workup: Peripheral Nerve Injuries
Treatment: Peripheral Nerve Injuries
Follow-up: Peripheral Nerve Injuries
References
Further Reading
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References

  1. Noble J, Munro CA, Prasad VS. Analysis of upper and lower extremity peripheral nerve injuries in a population of patients with multiple injuries. J Trauma. Jul 1998;45(1):116-22. [Medline].

  2. Omer GE, Spinner M, Van Beek AL. Management of Peripheral Nerve Problems. 1998.

  3. Sunderland S. Nerve and Nerve Injuries. 1978.

  4. Sanders VM, Jones KJ. Role of immunity in recovery from a peripheral nerve injury. J Neuroimmune Pharmacol. Mar 2006;1(1):11-9. [Medline].

  5. Seddon HJ. Three types of nerve injuries. Brain. 1943;66:237.

  6. Sunderland S. A classification of peripheral nerve injuries producing loss of function. Brain. 1951;74:491-516.

  7. Boivin A, Pineau I, Barrette B, Filali M, Vallières N, Rivest S, et al. Toll-like receptor signaling is critical for Wallerian degeneration and functional recovery after peripheral nerve injury. J Neurosci. Nov 14 2007;27(46):12565-76. [Medline].

  8. Mackinnon SE, Dellon AL. Surgery of the Peripheral Nerve. 1988.

  9. Elfar JC, Jacobson JA, Puzas JE, Rosier RN, Zuscik MJ. Erythropoietin accelerates functional recovery after peripheral nerve injury. J Bone Joint Surg Am. Aug 2008;90(8):1644-53. [Medline].

  10. Lykissas MG, Korompilias AV, Vekris MD, Mitsionis GI, Sakellariou E, Beris AE. The role of erythropoietin in central and peripheral nerve injury. Clin Neurol Neurosurg. Oct 2007;109(8):639-44. [Medline].

  11. Ducic I, Mafi AA, Attinger CE, Couch K, Al-Attar A. The role of peripheral nerve surgery in the management of painful chronic wounds: indications and outcomes. Plast Reconstr Surg. Jul 2008;122(1):193-7. [Medline].

  12. Taras JS, Jacoby SM. Repair of lacerated peripheral nerves with nerve conduits. Tech Hand Up Extrem Surg. Jun 2008;12(2):100-6. [Medline].

  13. Novak CB, Mackinnon SE, Williams JI. Establishment of reliability in the evaluation of hand sensibility. Plast Reconstr Surg. Aug 1993;92(2):311-22. [Medline].

  14. Strauch B, Lang A, Ferder M. The ten test. Plast Reconstr Surg. Apr 1997;99(4):1074-8. [Medline].

  15. Gelberman RH. Operative Nerve Repair and Reconstruction. 1991.

  16. Kline DG, Hudson AR. Nerve Injuries - Operative Results for Major Nerve Injuries, Entrapment and Tumor. 1995.

  17. Seddon HJ. Nerve grafting. Journal of Bone & Joint Surgery. 1963;43B:447-461.

  18. Mackinnon SE, Novak CB. Nerve transfers. New options for reconstruction following nerve injury. Hand Clin. Nov 1999;15(4):643-66, ix. [Medline].

  19. Oberlin C, Beal D, Leechavengvongs S. Nerve transfer to biceps muscle using a part of ulnar nerve for C5-C6 avulsion of the brachial plexus: anatomical study and report of four cases. J Hand Surg [Am]. Mar 1994;19(2):232-7. [Medline].

  20. Xu WD, Lu JZ, Qiu YQ, Jiang S, Xu L, Xu JG, et al. Hand prehension recovery after brachial plexus avulsion injury by performing a full-length phrenic nerve transfer via endoscopic thoracic surgery. J Neurosurg. Jun 2008;108(6):1215-9. [Medline].

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Further Reading

EFNS guidelines on the use of skin biopsy in the diagnosis of peripheral neuropathy.
European Federation of Neurological Societies - Medical Specialty Society.  2005 Oct.  12 pages.  NGC:005166
 
Management of paraneoplastic neurological syndromes: report of an EFNS Task Force.
European Federation of Neurological Societies - Medical Specialty Society.  2006 Jul.  9 pages.  NGC:005486

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Keywords

peripheral nerve injuries, peripheral nervous system, epineurium, perineurium, endoneurium, spinal nerves, ganglia, mononeuropathy, polyneuropathy, nerve repair, traumatic nerve injuries, nerve compression, traumatic peripheral nerve lesions, nerve injury, nerve injuries, brachial plexus injury, radial nerve injury

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Contributor Information and Disclosures

Author

Christine B Novak, PT, MS, Clinical Coordinator, Division of Plastic and Reconstructive Surgery, Research Associate Professor, Department of Surgery, Division of Plastic and Reconstructive Surgery, Washington University School of Medicine
Christine B Novak, PT, MS is a member of the following medical societies: American Association for Hand Surgery
Disclosure: Nothing to disclose.

Coauthor(s)

Susan E Mackinnon, MD, FRCSC, FACS, Program Director, Division of Plastic and Reconstructive Surgery, Shoenberg Professor and Chief, Department of Surgery, Division of Plastic and Reconstructive Surgery, Washington University School of Medicine
Susan E Mackinnon, MD, FRCSC, FACS is a member of the following medical societies: American Association for Hand Surgery, American Association of Plastic Surgeons, American College of Surgeons, American Society for Surgery of the Hand, American Surgical Association, Canadian Medical Association, and Canadian Society of Plastic Surgeons
Disclosure: Nuerotube Honoraria Consulting

Mark E Baratz, MD, Professor, Department of Orthopaedics, Drexel University College of Medicine; Residency Director, Department of Orthopaedics, Allegheny General Hospital; Consulting Staff, Allegheny Orthopaedic Associates
Mark E Baratz, MD is a member of the following medical societies: Allegheny County Medical Society, American Academy of Orthopaedic Surgeons, American Association for Hand Surgery, American Orthopaedic Association, American Society for Surgery of the Hand, Orthopaedic Research Society, and Pennsylvania Orthopaedic Society
Disclosure: Nothing to disclose.

Medical Editor

Michael S Clarke, MD, Clinical Associate Professor, Department of Orthopedic Surgery, University of Missouri-Columbia School of Medicine
Michael S Clarke, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Academy of Pediatrics, American Association for Hand Surgery, American College of Surgeons, American Medical Association, Arthroscopy Association of North America, Clinical Orthopaedic Society, Mid-Central States Orthopaedic Society, and Missouri State Medical Association
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

Samuel Agnew, MD, FACS, Associate Professor, Departments of Orthopedic Surgery and Surgery, Chief of Orthopedic Trauma, University of Florida at Jacksonville; Consulting Surgeon, Department of Orthopedic Surgery, McLeod Regional Medical Center
Samuel Agnew, MD, FACS is a member of the following medical societies: American Association for the Surgery of Trauma, American College of Surgeons, Orthopaedic Trauma Association, and Southern Orthopaedic Association
Disclosure: Nothing to disclose.

CME Editor

Dinesh Patel, MD, FACS, Associate Clinical Professor of Orthopedic Surgery, Harvard Medical School; Chief of Arthroscopic Surgery, Department of Orthopedic Surgery, Massachusetts General Hospital
Dinesh Patel, MD, FACS is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Association of Physicians of Indian Origin, American College of International Physicians, and American College of Surgeons
Disclosure: Nothing to disclose.

Chief Editor

Mary Ann E Keenan, MD, Professor, Vice Chair for Graduate Medical Education, Department of Orthopedic Surgery, University of Pennsylvania School of Medicine; Chief of Neuro-Orthopedics Program, Department of Orthopedic Surgery, Hospital of the University of Pennsylvania
Mary Ann E Keenan, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Orthopaedic Surgeons, American Orthopaedic Association, American Orthopaedic Foot and Ankle Society, American Society for Surgery of the Hand, and Orthopaedic Rehabilitation Association
Disclosure: Nothing to disclose.

 
 
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