Complications with Peripheral Nerve Injury: Difference between revisions
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== Introduction == | == Introduction == | ||
Secondary complications of peripheral nerve injury can be a significant issue and | Peripheral nerve injuries are common conditions with broad ranging groups of symptoms depending on the severity and nerves involved. Peripheral nerves convey signals between the spinal cord and the rest of the body. Nerves are comprised of various combinations of motor, sensory, and autonomic neurons.<ref>Menorca RM, Fussell TS, Elfar JC. [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4408553/ Peripheral nerve trauma: mechanisms of injury and recovery.] Hand clinics. 2013 Aug;29(3):317.</ref>Thus injury to peripheral nerves can have various secondary complications. Secondary complications of peripheral nerve injury can be a significant issue and have long term effect based upon the [[Classification of Peripheral Nerve Injury|severity of nerve injury]]. | ||
== Reduced Sensation == | == Reduced Sensation == | ||
Peripheral nerve injury is often associated with changes in sensation, with numbness and in some cases complete loss of sensation, which can increase the incidence of secondary injuries such as pressure ulcers, burns, and lacerations.<ref>Ginny, G, Chapter 18 - Peripheral Nerve Injuries. In Editors: Cameron, MH and Monroe, LG. Physical Rehabilitation, W.B. Saunders, 2007, Pages 473-513,</ref> | Peripheral nerve injury is often associated with changes in sensation, with numbness and in some cases complete loss of sensation, which can increase the incidence of secondary injuries following reduced sensation such as [[Pressure Ulcers|pressure ulcers]], [[Burns Overview|burns,]] and lacerations.<ref>Ginny, G, Chapter 18 - Peripheral Nerve Injuries. In Editors: Cameron, MH and Monroe, LG. Physical Rehabilitation, W.B. Saunders, 2007, Pages 473-513,</ref> | ||
=== Pressure Ulcers === | === Pressure Ulcers === | ||
Patients with decreased sensation as a result of a peripheral nerve injury are at increased risk of developing pressure ulcers, which can be harder to see on dark skin. A pressure ulcer is a | [[File:Pressure sore in patient with foot drop.jpg|thumb|Pressure sore in patient with foot drop]] | ||
Patients with decreased sensation as a result of a peripheral nerve injury are at increased risk of developing pressure ulcers, which can be harder to see on dark skin. A pressure ulcer is a localized injury to the skin and/or underlying tissue usually over a bony prominence, as a result of pressure, or pressure in combination with shear. A pressure sore can develop in a few hours, but the results can last for many months and can cause significant loss of function and impairment. A number of contributing or confounding factors are associated with pressure ulcers; but the significance of these factors is yet to be elucidated. Tissue injury is related to both extrinsic and intrinsic factors. | |||
* Extrinsic factors include ''pressure, shear, friction'', ''immobility'', and ''moisture.'' | * Extrinsic factors include ''pressure, shear, friction'', ''immobility'', and ''moisture.'' | ||
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Secondary injuries in patients with decreased sensation can be common following peripheral nerve injury, with burn and skin lacerations common through contact with hot surfaces or water, sharp surfaces or not using protective clothing, e.g. shoes. | Secondary injuries in patients with decreased sensation can be common following peripheral nerve injury, with burn and skin lacerations common through contact with hot surfaces or water, sharp surfaces or not using protective clothing, e.g. shoes. | ||
Test water with the opposite, or sensate limb, and always wear covered, supportive shoes if foot sensation is reduced | Test water with the opposite, or sensate limb, and always wear covered, supportive shoes if foot sensation is reduced. | ||
== Pain and Hypersensitivity == | == Pain and Hypersensitivity == | ||
Significant pain can occur with peripheral nerve injury, particularly with nerve root avulsions, causing neuropathic pain. Severe pain will also exhaust the client and if not treated appropriately will hinder physiotherapy rehabilitation. Pain control is of paramount importance.<ref>Michael D Robinson, Steven Shannon.Rehabilitation of peripheral nerve injuries.PMID: 11878078.DOI: 10.1016/s1047-9651(03)00074-3.PubMed.gov. National Library of Medicine. National Centre for Biotechnology Information.</ref> | Significant pain can occur with peripheral nerve injury, particularly with nerve root avulsions, causing [[Neuropathic Pain|neuropathic pain]]. Severe pain will also exhaust the client and if not treated appropriately will hinder physiotherapy rehabilitation. Pain control is of paramount importance.<ref>Michael D Robinson, Steven Shannon.Rehabilitation of peripheral nerve injuries.PMID: 11878078.DOI: 10.1016/s1047-9651(03)00074-3.PubMed.gov. National Library of Medicine. National Centre for Biotechnology Information.</ref> | ||
== Delayed Healing == | == Delayed Healing == | ||
Peripheral nerve injury can have an impact on healing, and slow down the healing mechanisms of the skin. | Peripheral nerve injury can have an impact on healing, and slow down the healing mechanisms of the skin. Peripheral nerve injury associated with diabetes milletus type 2 can impaired wound healing process. Peripheral nerve injury can lead to weakness of muscles of extremities which may hamper the circulation of blood in distal limbs causing swelling and thus poor healing. | ||
== Swelling == | == Swelling == | ||
As peripheral nerve injury causes motor impairment in extremities, it affects muscles in pumping blood from distal aspect of limbs , mainly in sciatic nerve injury. This can hamper the effective blood circulation and leads to blood pooling in distal limbs when limbs are in gravity-dependent position. | |||
== Contracture and Deformity == | == Contracture and Deformity == | ||
If the joints of the affected muscles are not moved passively in daily basis, in long term, muscles shorten and joint become stiff causing contracture and deformities. | |||
== Neuroma == | == Neuroma == | ||
Neuromas are a non-cancerous thickening of nerve fibres made of non-conducting tissue that stops the signal from being sent along the nerve. Neuromas are thought to be formed when nerve regeneration is blocked by scar tissue, preventing further regeneration. Neuromas are a potential, limiting complication of nerve recovery which can cause pain or hypersensitivity; they usually do not develop until at least six weeks post-injury. Movement of adjacent tissues or direct application of pressure on neuromas often causes pain by stimulating the nerve enclosed by the neuroma. | Neuromas are a non-cancerous thickening of nerve fibres made of non-conducting tissue that stops the signal from being sent along the nerve. Neuromas are thought to be formed when nerve regeneration is blocked by scar tissue, preventing further regeneration. Neuromas are a potential, limiting complication of nerve recovery which can cause pain or hypersensitivity; they usually do not develop until at least six weeks post-injury. Movement of adjacent tissues or direct application of pressure on neuromas often causes pain by stimulating the nerve enclosed by the neuroma. | ||
== | == Weakness == | ||
Involvement of motor nerve causes weakness of muscles supplied by that nerve. Muscle atrophy can be significantly seen in long term. | |||
== | == Psychological Stress == | ||
Physical weakness, pain and deformities can hamper the mental status of the person causing post traumatic stress disorder and depression in long term. | |||
== References == | == References == | ||
Revision as of 12:59, 2 April 2022
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Top Contributors - Naomi O'Reilly, Tarina van der Stockt, Kim Jackson and Manisha Shrestha
Introduction[edit | edit source]
Peripheral nerve injuries are common conditions with broad ranging groups of symptoms depending on the severity and nerves involved. Peripheral nerves convey signals between the spinal cord and the rest of the body. Nerves are comprised of various combinations of motor, sensory, and autonomic neurons.[1]Thus injury to peripheral nerves can have various secondary complications. Secondary complications of peripheral nerve injury can be a significant issue and have long term effect based upon the severity of nerve injury.
Reduced Sensation[edit | edit source]
Peripheral nerve injury is often associated with changes in sensation, with numbness and in some cases complete loss of sensation, which can increase the incidence of secondary injuries following reduced sensation such as pressure ulcers, burns, and lacerations.[2]
Pressure Ulcers[edit | edit source]
Patients with decreased sensation as a result of a peripheral nerve injury are at increased risk of developing pressure ulcers, which can be harder to see on dark skin. A pressure ulcer is a localized injury to the skin and/or underlying tissue usually over a bony prominence, as a result of pressure, or pressure in combination with shear. A pressure sore can develop in a few hours, but the results can last for many months and can cause significant loss of function and impairment. A number of contributing or confounding factors are associated with pressure ulcers; but the significance of these factors is yet to be elucidated. Tissue injury is related to both extrinsic and intrinsic factors.
- Extrinsic factors include pressure, shear, friction, immobility, and moisture.
- Intrinsic factors relate to the condition of the patient, such as sepsis, local infection, decreased autonomic control, altered level of consciousness, increased age, vascular occlusive disease, anaemia, malnutrition, sensory loss, and contracture.
Keeping skin dry, regular position changes and regular skin checks (use a mirror if necessary) will help.
Read more here about the prevention and management of Pressure Ulcers
Burns and Lacerations[edit | edit source]
Secondary injuries in patients with decreased sensation can be common following peripheral nerve injury, with burn and skin lacerations common through contact with hot surfaces or water, sharp surfaces or not using protective clothing, e.g. shoes.
Test water with the opposite, or sensate limb, and always wear covered, supportive shoes if foot sensation is reduced.
Pain and Hypersensitivity[edit | edit source]
Significant pain can occur with peripheral nerve injury, particularly with nerve root avulsions, causing neuropathic pain. Severe pain will also exhaust the client and if not treated appropriately will hinder physiotherapy rehabilitation. Pain control is of paramount importance.[3]
Delayed Healing[edit | edit source]
Peripheral nerve injury can have an impact on healing, and slow down the healing mechanisms of the skin. Peripheral nerve injury associated with diabetes milletus type 2 can impaired wound healing process. Peripheral nerve injury can lead to weakness of muscles of extremities which may hamper the circulation of blood in distal limbs causing swelling and thus poor healing.
Swelling[edit | edit source]
As peripheral nerve injury causes motor impairment in extremities, it affects muscles in pumping blood from distal aspect of limbs , mainly in sciatic nerve injury. This can hamper the effective blood circulation and leads to blood pooling in distal limbs when limbs are in gravity-dependent position.
Contracture and Deformity[edit | edit source]
If the joints of the affected muscles are not moved passively in daily basis, in long term, muscles shorten and joint become stiff causing contracture and deformities.
Neuroma[edit | edit source]
Neuromas are a non-cancerous thickening of nerve fibres made of non-conducting tissue that stops the signal from being sent along the nerve. Neuromas are thought to be formed when nerve regeneration is blocked by scar tissue, preventing further regeneration. Neuromas are a potential, limiting complication of nerve recovery which can cause pain or hypersensitivity; they usually do not develop until at least six weeks post-injury. Movement of adjacent tissues or direct application of pressure on neuromas often causes pain by stimulating the nerve enclosed by the neuroma.
Weakness[edit | edit source]
Involvement of motor nerve causes weakness of muscles supplied by that nerve. Muscle atrophy can be significantly seen in long term.
Psychological Stress[edit | edit source]
Physical weakness, pain and deformities can hamper the mental status of the person causing post traumatic stress disorder and depression in long term.
References [edit | edit source]
- ↑ Menorca RM, Fussell TS, Elfar JC. Peripheral nerve trauma: mechanisms of injury and recovery. Hand clinics. 2013 Aug;29(3):317.
- ↑ Ginny, G, Chapter 18 - Peripheral Nerve Injuries. In Editors: Cameron, MH and Monroe, LG. Physical Rehabilitation, W.B. Saunders, 2007, Pages 473-513,
- ↑ Michael D Robinson, Steven Shannon.Rehabilitation of peripheral nerve injuries.PMID: 11878078.DOI: 10.1016/s1047-9651(03)00074-3.PubMed.gov. National Library of Medicine. National Centre for Biotechnology Information.
