Complications with Peripheral Nerve Injury

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Introduction

Secondary complications of peripheral nerve injury can be a significant issue and impact of the rehabilitation process, and

Reduced Sensation

Injury to the sensory component of a peripheral nerve can cause abnormal sensations (paresthesias), increased sensitivity (e.g., hyperalgesia to pinprick, brushing/cooling allodynia, pain), diminished sensation (hypesthesia), or total loss of sensation (anesthesia) in the distribution of the affected nerve, all of which can impact on rehabilitation following peripheral nerve injury. While we need to be able to manage pain and hypersensitivity to progress rehabilitation it is also vital to be aware of the secondary complications as a result of altered sensation inlcuding pressure ulcers, burns and lacerations.

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.

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 localised 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

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

Delayed Healing

Peripheral nerve injury can have an impact on healing, and slow down the healing mechanisms of the skin.

Neuroma

A non-cancerous thickening of nerve fibres made of non-conducting tissue that stops the signal from being sent along the nerve. 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.