Long standing nerve injury
Long standing nerve injury: Although sensory nerve repairs may restore
sensation sensory recovery even after considerable treatment delays, there
is a limited window of opportunity for functional nerve recovery in at
least three situations.
1. Over time, muscles paralyzed by nerve injury lose their capacity to
recover. The further from the hand the nerve is injured, the longer it
takes for nerve fibers to grow back down to the paralyzed muscles.
Functional muscle recovery is unlikely to occur in muscles paralyzed for
over eighteen months. Taking into account the average rate of nerve
recovery, a rough guide is that if the sum of
Number of months between injury and surgery
+ Distance in inches between injury site and muscle belly
is greater than eighteen, muscle recovery is not likely. Fortunately, this
guide is not always true.
2. If fixed joint contractures have developed as a result of paralysis,
muscle recovery is unlikely to result in normal motion, even if the
contractures are surgically released. Common situations include proximal
interphalangeal joint contracture in ulnar nerve palsy or first web space
contracture in median nerve palsy.
3. If an adult patient has developed extremity disuse due to long standing
anesthesia or chronic pain, nerve repair is unlikely to restore function.
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