Nerve Injury Discussion

Nerve injuries are a difficult problem for which there may be no satisfactory surgical solution. Recovery depends on the exact type and degree of injury. Following a closed injury, if the nerve is simply bruised or otherwise subjected to a minor irritation, there may be profound dysfunction followed by full or near full recovery. Adjacent infection, inflammation, scar tissue, or inadequate soft tissue cover may produce injury by affecting blood supply to the nerve. If there is significant mechanical injury, recovery is entirely unpredictable. Electrical nerve tests or surgical exploration may be indicated if a nerve injury which might require repair or decompression is strongly suspected. If a nerve is actually crushed, cut or torn, conservative treatment rarely if ever results in recovery of sensation or strength to the area supplied by the damaged nerve and gives the greatest risk of painful neuroma symptoms at the site of injury. Nerve exploration and repair improves the chance of recovery and in theory reduces the degree of expected neuroma symptoms. Unfortunately, scar tissue around a nerve from previous surgery or trauma may obscure the natural appearance of a nerve to the point that it can not be distinguished from scar. For this reason, secondary or late nerve explorations always carry the risk of actually worsening nerve damage. Even with a technically perfect microsurgical repair, sensation and strength cannot be expected to fully recover, although improvement often occurs. Protection of the nerve repair and therapy is usually required. Rupture of the nerve repair is possible postoperatively and it is possible that there will be no improvement, even with surgery. Neuroma related tenderness resulting in an electrical shock sensation always remains at the site of nerve injury, although with repair and regeneration, this usually diminishes in time. Nerve recovery is slow, and several years are usually needed before there is a final plateau in improvement. With recovery, patients may develop progressively worsening tenderness or unpleasant sensations referred to as reinnervation hypersensitivity. This usually responds to therapy of sensory reeducation and desensitization techniques, but occasionally may require additional surgical intervention. Nerve injuries in childhood are usually followed by some degree of growth retardation in the area supplied by the nerve. Because of numbness, the area is subject to injury from heat, cold and sharp or abrasive surfaces.

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