Rehabilitation of Peripheral Nerve Injuries in Disasters and Conflicts: Difference between revisions
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== Introduction == | == Introduction == | ||
Peripheral nerves can sustain injury from numerous causes including traumatic | Peripheral nerves can sustain injury from numerous causes including traumatic thermal, chemical, or mechanical injury, inherited causes, infections, collagen or metabolic diseases ([[Diabetes|diabetes mellitus]] being one of the most common), exposure to endogenous or exogenous toxins; malignancies and iatrogenic causes<ref>Mayo Clinic. Peripheral Neuropathy. Available from: https://www.mayoclinic.org/diseases-conditions/peripheral-neuropathy/symptoms-causes/syc-20352061 (Last Accessed 24/03/2019)</ref>, which manifest with neurological deficits distal to the level of the lesion. In disaster and conflict situations there can be a significant increase in the number of traumatic peripheral nerve injuries, but all of these other causes of nerve injury will continue to be seen by patients in these situations. | ||
Peripheral nerve injuries are | |||
Bone or joint injury is often associated with peripheral nerve lesions. Primary injury of a peripheral nerve may result from the same trauma that injures a bone or joint; however, sometimes the neural injury is caused by displaced osseous fragments, by stretching, or by manipulation, rather than by the initial injuring force. Secondary injury results from involvement of the nerve by infection, scar, callus, or vascular complications. These complications include haematoma, arteriovenous fistula, ischemia, or aneurysm. | |||
In disaster and conflict situations peripheral nerve injuries can be missed when medical or surgical team prioritise working to save limb or life, and rehabilitation professionals are often the first member of the team to identify possible nerve complications during their assessment and treatment. As such rehabilitation professionals should always ensure that every patient who has injured a limb or limb girdle should be evaluated and monitored for any possible peripheral nerve damage, in particular post surgery, manipulation, casting, and recovery from skeletal injury to detect any possible secondary neural injury. | |||
== Peripheral Nerve Injury Overview == | == Peripheral Nerve Injury Overview == | ||
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== Classification of Peripheral Nerve Injuries == | == Classification of Peripheral Nerve Injuries == | ||
Classification systems provides a common language for medical and rehabilitation professionals to effectively discuss nerve pathophysiology. There are two commonly used classification systems in use for peripheral nerve injury; the Seddon Classification and the Sunderland Classification. | Classification systems provides a common language for medical and rehabilitation professionals to effectively discuss nerve pathophysiology. There are two commonly used classification systems in use for peripheral nerve injury; the Seddon Classification and the Sunderland Classification. <ref name=":0">Campbell WW. Evaluation and Management of Peripheral Nerve Injury. Clinical Neurophysiology. 2008 Sep 30;119(9):1951-65.</ref><ref>Lee SK, Wolfe SW. Peripheral Nerve Injury and Repair. Journal of the American Academy of Orthopaedic Surgeons. 2000 Jul 1;8(4):243-52.</ref> Seddon was the first to classify nerve injuries into three categories; neurapraxia, axonotmesis, and neurotmesis, based on the presence of demyelination and the extent of damage to the axons and the connective tissues of the nerve. Sunderland later expanded on this initial classification to distinguish the extent of damage in the connective tissues. McKennon and Dellon introduced a further classification to denote combinations of Grade III-V injuries along a damaged nerve, although it is not as widely accepted in use.<ref name=":1">Menorca RM, Fussell TS, Elfar JC. Peripheral Nerve Trauma: Mechanisms of Injury and Recovery. Hand Clinics. 2013 Aug;29(3):317.</ref> | ||
Seddon was the first to classify nerve injuries into three categories; neurapraxia, axonotmesis, and neurotmesis, based on the presence of demyelination and the extent of damage to the axons and the connective tissues of the nerve. Sunderland later expanded on this initial classification to distinguish the extent of damage in the connective tissues. | |||
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|+'''Table.1''' Peripheral Nerve Injury Classification Systems | |+'''Table.1''' Peripheral Nerve Injury Classification Systems <ref name=":0" /><ref name=":1" /> | ||
|- | |- | ||
! scope="col" |'''Seddon Classification''' | ! scope="col" |'''Seddon Classification''' |
Revision as of 20:34, 23 April 2022
Original Editors - Naomi O'Reilly
Top Contributors - Naomi O'Reilly, Tarina van der Stockt, Kim Jackson and Jess Bell
Introduction[edit | edit source]
Peripheral nerves can sustain injury from numerous causes including traumatic thermal, chemical, or mechanical injury, inherited causes, infections, collagen or metabolic diseases (diabetes mellitus being one of the most common), exposure to endogenous or exogenous toxins; malignancies and iatrogenic causes[1], which manifest with neurological deficits distal to the level of the lesion. In disaster and conflict situations there can be a significant increase in the number of traumatic peripheral nerve injuries, but all of these other causes of nerve injury will continue to be seen by patients in these situations.
Peripheral nerve injuries are
Bone or joint injury is often associated with peripheral nerve lesions. Primary injury of a peripheral nerve may result from the same trauma that injures a bone or joint; however, sometimes the neural injury is caused by displaced osseous fragments, by stretching, or by manipulation, rather than by the initial injuring force. Secondary injury results from involvement of the nerve by infection, scar, callus, or vascular complications. These complications include haematoma, arteriovenous fistula, ischemia, or aneurysm.
In disaster and conflict situations peripheral nerve injuries can be missed when medical or surgical team prioritise working to save limb or life, and rehabilitation professionals are often the first member of the team to identify possible nerve complications during their assessment and treatment. As such rehabilitation professionals should always ensure that every patient who has injured a limb or limb girdle should be evaluated and monitored for any possible peripheral nerve damage, in particular post surgery, manipulation, casting, and recovery from skeletal injury to detect any possible secondary neural injury.
Peripheral Nerve Injury Overview[edit | edit source]
The peripheral nervous system is comprised of three types of cells: neuronal cells, glial cells, and stromal cells. 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. Efferent neurons (motor and autonomic) receive signals through their dendrites from neurons of the central nervous system, primarily using the neurotransmitter acetylcholine among others. Afferent (sensory) neurons receive their signals through their dendrites from specialized cell types, such as Paccinian corpuscles for fine sensation and others. These signals are sent to the CNS to provide sensory information to the brain and possibly interneurons in the spinal cord when a reflex response is necessary1.
A peripheral nerve injury can result in a minor injury or a fully severed nerve. Based on the type and amount of damage, nerve regeneration may or may not be possible. Peripheral nerve Injury treatment depends on the type of injury, symptoms and the amount of nerve injury sustained.
Classification of Peripheral Nerve Injuries[edit | edit source]
Classification systems provides a common language for medical and rehabilitation professionals to effectively discuss nerve pathophysiology. There are two commonly used classification systems in use for peripheral nerve injury; the Seddon Classification and the Sunderland Classification. [2][3] Seddon was the first to classify nerve injuries into three categories; neurapraxia, axonotmesis, and neurotmesis, based on the presence of demyelination and the extent of damage to the axons and the connective tissues of the nerve. Sunderland later expanded on this initial classification to distinguish the extent of damage in the connective tissues. McKennon and Dellon introduced a further classification to denote combinations of Grade III-V injuries along a damaged nerve, although it is not as widely accepted in use.[4]
Seddon Classification | Sunderland Classification | McKennon & Dellon | Type of Injury |
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Neuropraxia | Grade I |
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Axonotmesis | Grade II |
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Grade III |
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Grade IV |
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Neurotmesis | Grade V |
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Grade VI | Mixed levels of injury along the nerve |
Common Peripheral Nerve Injuries[edit | edit source]
Upper Limb[edit | edit source]
Nerve | Related Injuries | Muscle Affected | Motor Function | Sensation | Test |
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Spinal Accessory Nerve |
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Posture
Test
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Long Thoracic Nerve |
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Axillary Nerve | Most common peripheral nerve injury to affect the shoulder.
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Suprascapular Nerve |
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Musculocutaneous Nerve | Isolated injury to the Musculocutaneous Nerve is rare
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Ulnar Nerve | At risk of Injury at Medial Epicondyle, in Cubital Tunnel, or at the Wrist;
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Forearm: | High Lesion - Ulnar Paradox;
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Hand
Hypothenar Eminence; Thenar Eminence; Short Muscles; |
Low Lesion - Partial Claw Hand;
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Radial Nerve |
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Arm | High Lesion;
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No Sensory Involvement if Posterior Interosseous Branch is Damaged Alone
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Forearm; | Middle & Low Lesion;
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Median Nerve | Forearm; | High Lesion;
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Low Lesion;
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Hand; LOAF | Carpal Tunnel;
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Lower Limb[edit | edit source]
Nerve | Related Injuries | Muscle Affected | Motor Function | Sensation | Test |
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Gluteal Nerve |
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Femoral Nerve |
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Tibial Nerve |
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Peroneal Nerve |
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Resources[edit | edit source]
Early Rehabilitation in Conflict and Disasters, Humanity and Inclusion
Rehabilitation in Sudden Onset Disasters, Humanity and Inclusion
References [edit | edit source]
- ↑ Mayo Clinic. Peripheral Neuropathy. Available from: https://www.mayoclinic.org/diseases-conditions/peripheral-neuropathy/symptoms-causes/syc-20352061 (Last Accessed 24/03/2019)
- ↑ 2.0 2.1 Campbell WW. Evaluation and Management of Peripheral Nerve Injury. Clinical Neurophysiology. 2008 Sep 30;119(9):1951-65.
- ↑ Lee SK, Wolfe SW. Peripheral Nerve Injury and Repair. Journal of the American Academy of Orthopaedic Surgeons. 2000 Jul 1;8(4):243-52.
- ↑ 4.0 4.1 Menorca RM, Fussell TS, Elfar JC. Peripheral Nerve Trauma: Mechanisms of Injury and Recovery. Hand Clinics. 2013 Aug;29(3):317.