eMedicine Specialties > Orthopedic Surgery > Trauma

Peripheral Nerve Injuries: Follow-up

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

Outcome and Prognosis

With restoration of nerve continuity, axons may regenerate and, thus, reinnervate the motor end plates and sensory receptors. When the nerve injury is very proximal (ie, brachial plexus injury, sciatic nerve injury), nerve regeneration may not occur in sufficient time for muscle reinnervation. For example, in a lower trunk brachial plexus injury, reinnervation of the ulnar nerve intrinsic hand muscles is not possible due to the long period of muscle denervation because of the long distance necessary for nerve regeneration. However, if surgery is performed within 3-6 months following nerve injury, the patient is expected to recover use of most muscles, excluding muscles in the hand or foot in injuries at the trunk level or higher. Distal nerve transfers are used to recover distal extremity motor function.

Future and Controversies

The future in peripheral nerve injuries lies in maximizing motor and sensory recovery following nerve injury. Strategies to maintain the neuromuscular junction are important to permit muscle reinnervation following prolonged muscle denervation, in addition to decreasing injury to the cell body.

In traumatic nerve injury with large nerve gaps, nerve allografts may be considered. However, because of the morbidity associated with immunosuppression, the use of the nerve allograft has been limited to otherwise unreconstructable injuries. Investigations to decrease the antigenicity of the allograft and/or induce tolerance to the nerve allograft are ongoing, and success in these investigations will permit the use of nerve allografts without immunosuppression.

 


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

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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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