Nerve Injury

Nerve Injury

·        Types:

o  Neuropraxia: transient loss due to external pressure 

o  Aconotmesis: loss of function for weeks/months due to more severe compression. No loss of neuronal continuity

o  Neurotmesis: nerve division.  No recovery without surgical repair

·        Mechanisms: Division, stretching, crushing, ischaemia alone or in combination

·        Common sites:

o  Upper Limb:

§  Median nerve: hand through window

§  Ulnar nerve at elbow: fracture or pressure

§  Radial nerve: cuts around the elbow

§  Digital nerve: finger cuts 

§  Brachial plexus: Downward pressure at the shoulder damages the upper cord, upward pressure damages lower cord

§  Cervical nerve roots: compression of vertebrae

o  Lower Limb:

§  Common peroneal nerve: damage at the neck of the fibula

§  Lumbar nerve roots: prolapsed discs

§  Sciatic nerve: hip dislocation

·        Management:

o  Immediate primary suture: if clean cut

o  Secondary suture:  Clean and debride then suture two weeks later

o  Cable Grafts: if long area of damage: graft from another nerve