Further Outpatient Care
See the list below:
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Continuation of physical therapy and/or occupational therapy and follow-up with a surgeon and/or orthotist may be needed.
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Vocational rehabilitation and modifications at home and/or work are also assessed.
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In some cases, repeated electrodiagnostic evaluations may be required for prognostication and further treatment planning. These tests can be used to detect early signs of muscle reinnervation several months before clinically evident muscle contractions appear.
Further Inpatient Care
See the list below:
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If physical therapy is not initiated promptly after surgery, denervation can occur and can result in muscle atrophy and fibrosis, joint stiffness, motor endplate atrophy, and trophic skin changes.
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Grant and colleagues do not advocate the traditional treatment, which involves several weeks of immobilization. [38] Instead, the use of a short period to allow healing and adequate strengthening of the repair site is advised.
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Repairs (nerve transfer/neurotization, as well as tendon transfer) are protected by means of relaxed joint posturing for about 3 weeks.
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To prevent disruption of the sutures at the repair site, the patient should avoid strenuous physical activity.
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In nerve transfers, the extremity is immobilized for 4 weeks after surgery, at which time physical therapy is initiated.
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Postoperative clinical examinations are performed every 3 months for the first 2 years after surgery and every 6 months after that.
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At each postoperative visit, the ROM, strength, and sensation in the treated area should be tested, and the results should be documented.
Inpatient & Outpatient Medications
See the list below:
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A variety of medications may be required, mainly for the management of associated painful states.
Transfer
See the list below:
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When indicated, the patient may be admitted to the hospital for orthopedic or neurosurgical procedures.
Deterrence
See the list below:
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Measures that the patient can use to prevent setbacks and further damage include the following:
Protecting the damaged limb from repeat injury and extremes of motion
Maintaining the functional ROM
Strengthening muscles in the cervical region and limbs
Making appropriate modifications in the workplace and/or at home
Complications
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Late complications may include the following:
Pain syndromes, such as persistent neuropathy, neuroma, and CRPS II
Skin damage and infection
Significant muscle atrophy
Contracture and capsulitis
Subluxation
Sensory loss
Osteopenia
Heterotopic ossification
Myofascial pain
Depression and anxiety
Prognosis
See the list below:
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The outcome and prognosis of acute injury varies widely, depending on the type and etiology of injury and the timing of therapy. [5]
The extent of injury to neural tissue and the age and medical status of the injured patient are important factors that influence the outcome.
Patient compliance and motivation for recovery can also have an important effect on the overall success of therapy.
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With mild neurapraxic lesions, spontaneous recovery may occur only days or weeks after the trauma has occurred; following a gunshot wound, spontaneous recover may occur as late as 11 months later.
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Recovery from axonotmetic injuries usually occurs over months.
In axonotmesis, although axons regenerate, functional recovery depends on the associated injuries, the amount of healthy proximal axon that remains after injury, and the age of the patient.
Recovery is usually complete unless the injury is so proximal that atrophy of the motor endplate or sensory receptor occurs before the axon can grow back to these organs.
In cases of a coexisting root avulsion, the above scenario of a very proximal lesion, resulting in atrophy of the motor endplate or sensory receptor, may be possible. Therefore, healing may be greatly delayed or incomplete.
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In neurotmesis, regeneration occurs, but function rarely returns to its preinjury level.
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Generally, the rate of spontaneous recovery after shotgun wounds is lower than it is with other mechanisms.
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Neural injuries associated with fractures have a greater incidence of spontaneous resolution; generally, recovery is less common with neural injuries secondary to dislocations.
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Lesions resulting from shoulder dislocations heal within 12-45 weeks, depending on severity of the dislocation and, consequently, the type and extent of the associated neural injury or injuries.
Patient Education
See the list below:
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Educating the patient, family, and rehabilitation team, as well as medical practitioners involved in the patient's postdischarge care, may have several benefits.
It facilitates the coordination and planning of services.
It hastens the implementation of appropriate interventions.
It results in a better recovery.
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Of equal importance is addressing the associated psychological factors, with the aim of improving the following:
The patient's mood stability
The patient's coping skills
Family functioning
Pain management
Patient motivation
Patient participation in therapy
Overall outcome
