Neurolysis: Difference between revisions
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== Description<br> == | == Description<br> == | ||
Neurolysis is a the breaking down or freeing up of nerve tissues via surgery or chemical agents. This can be a permanent or temporary change. <ref>Tariq RA, Mueller M, Green MS. Neuraxial Neurolysis. [Updated 2022 Sep 26]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK537157/</ref> | |||
= | External neurolysis is releasing scar tissue from the nerve whilst internal neurolysis is releasing the compressed tissue.<ref name=":0">León-Andrino A, Noriega DC, Lapuente JP, Pérez-Valdecantos D, Caballero-García A, Herrero AJ, Córdova A. [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9144828 Biological Approach in the Treatment of External Popliteal Sciatic Nerve (Epsn) Neurological Injury: Review.] J Clin Med. 2022 May 16;11(10):2804. / </ref> | ||
== Indications == | |||
Neurolysis can be used for neural recovery in [[neuropathies]] or neural lesions, which includes: | |||
== Clinical | * [[Sciatica]]<ref>Veihelmann A. [https://pubmed.ncbi.nlm.nih.gov/30481838/ Spinal Injections, Epidural Neurolysis and Denervation for Specific Low Back Pain and Sciatica.] Z Orthop Unfall. 2019 Aug;157(4):417-425. English, German. </ref> | ||
* [[Brachial Plexus Injury|Brachial plexus injuries]]<ref name=":1">Rich JA, Newell A, Williams T. [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6936391/ Traumatic brachial plexus injury rehabilitation using neuromuscular electrical muscle stimulation in a polytrauma patient.] BMJ Case Rep. 2019 Dec 23;12(12):e232107. </ref> | |||
* [[Quadrilateral space syndrome]]<ref>Zurkiya O. [https://pubmed.ncbi.nlm.nih.gov/34815962/ Quadrilateral space syndrome.] Cardiovasc Diagn Ther. 2021 Oct;11(5):1112-1117. </ref> | |||
* [[Common Peroneal Nerve|Peroneal]] nerve palsy. <ref name=":2">Chow AL, Levidy MF, Luthringer M, Vasoya D, Ignatiuk A. [https://pubmed.ncbi.nlm.nih.gov/34397520/ Clinical Outcomes After Neurolysis for the Treatment of Peroneal Nerve Palsy: A Systematic Review and Meta-Analysis.] Ann Plast Surg. 2021 Sep 1;87(3):316-323. </ref>Peroneal is the third most common neuropathy after [[Median Nerve|median]] and [[Ulnar Nerve|ulnar]].<ref name=":0" /> | |||
Mechanisms of nerve injury include contusions, compression, traction, ischaemic, and dissection.<ref name=":0" /> | |||
Neurolysis can also be used for [[Chronic Pain|chronic]] intractable pain management. <ref>S. Safavi-Abbasi, I. Feiz-Erfan, A.G. Shetter, | |||
Neurolysis, Editor(s): Michael J. Aminoff, Robert B. Daroff, Encyclopedia of the Neurological Sciences (Second Edition), Academic Press, 2014. Pages 406-407. Available from: http://www.sciencedirect.com/science/article/abs/pii/B9780123851574007697</ref> <br> | |||
== | == Post-Op Management == | ||
After nerve injury, there are immediate changes in the peripheral and central nervous system, which continue through reinnervation and recovery. With reinnervation of the sensory receptors and motor endplates and appropriate cortical remapping, excellent functional outcome can be achieved following nerve injury and reconstruction. | |||
Rehabilitation to maximize outcome must include strategies directed toward the sensory and motor cortical remapping.<br> | |||
==== Early management ==== | |||
= | * Pain control | ||
* Oedema management | |||
* Immobilization may be advised by the surgeon. <ref name=":3">Novak CB, von der Heyde RL. [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4317280/ Rehabilitation of the upper extremity following nerve and tendon reconstruction: when and how.] Semin Plast Surg. 2015 Feb;29(1):73-80.</ref> | |||
==== Rehabilitation ==== | |||
Promoting nerve regeneration requires a varied treatment plan, aiming for sensory and motor cortical remapping. This can include strengthening, manual therapy, gym sessions, hydrotherapy, neuromuscular electrical stimulation and combined neurocognitive training . <ref name=":1" /> <ref name=":3" /><ref>Gohritz A, Laengle G, Boesendorfer A, Gesslbauer B, Gstoettner C, Politikou O, Sturma A, Aszmann OC. [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10142607/ Nerve Transfers for Brachial Plexus Reconstruction in Patients over 60 Years.] J Pers Med. 2023 Apr 12;13(4):659. </ref> | |||
== Complications == | |||
Risk of complications is low but includes postoperative [[Infection control|infection]], wound dehiscence, hematoma, bleeding, relapse of the neuropathy or [[sepsis]]. <ref name=":2" /> | |||
== References == | == References == | ||
<references /> | <references /> | ||
Revision as of 11:53, 26 May 2023
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Top Contributors - Chloe Waller, Lucinda hampton and Carina Therese Magtibay
Description
[edit | edit source]
Neurolysis is a the breaking down or freeing up of nerve tissues via surgery or chemical agents. This can be a permanent or temporary change. [1]
External neurolysis is releasing scar tissue from the nerve whilst internal neurolysis is releasing the compressed tissue.[2]
Indications[edit | edit source]
Neurolysis can be used for neural recovery in neuropathies or neural lesions, which includes:
- Sciatica[3]
- Brachial plexus injuries[4]
- Quadrilateral space syndrome[5]
- Peroneal nerve palsy. [6]Peroneal is the third most common neuropathy after median and ulnar.[2]
Mechanisms of nerve injury include contusions, compression, traction, ischaemic, and dissection.[2]
Neurolysis can also be used for chronic intractable pain management. [7]
Post-Op Management[edit | edit source]
After nerve injury, there are immediate changes in the peripheral and central nervous system, which continue through reinnervation and recovery. With reinnervation of the sensory receptors and motor endplates and appropriate cortical remapping, excellent functional outcome can be achieved following nerve injury and reconstruction.
Rehabilitation to maximize outcome must include strategies directed toward the sensory and motor cortical remapping.
Early management[edit | edit source]
- Pain control
- Oedema management
- Immobilization may be advised by the surgeon. [8]
Rehabilitation[edit | edit source]
Promoting nerve regeneration requires a varied treatment plan, aiming for sensory and motor cortical remapping. This can include strengthening, manual therapy, gym sessions, hydrotherapy, neuromuscular electrical stimulation and combined neurocognitive training . [4] [8][9]
Complications[edit | edit source]
Risk of complications is low but includes postoperative infection, wound dehiscence, hematoma, bleeding, relapse of the neuropathy or sepsis. [6]
References[edit | edit source]
- ↑ Tariq RA, Mueller M, Green MS. Neuraxial Neurolysis. [Updated 2022 Sep 26]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK537157/
- ↑ 2.0 2.1 2.2 León-Andrino A, Noriega DC, Lapuente JP, Pérez-Valdecantos D, Caballero-García A, Herrero AJ, Córdova A. Biological Approach in the Treatment of External Popliteal Sciatic Nerve (Epsn) Neurological Injury: Review. J Clin Med. 2022 May 16;11(10):2804. /
- ↑ Veihelmann A. Spinal Injections, Epidural Neurolysis and Denervation for Specific Low Back Pain and Sciatica. Z Orthop Unfall. 2019 Aug;157(4):417-425. English, German.
- ↑ 4.0 4.1 Rich JA, Newell A, Williams T. Traumatic brachial plexus injury rehabilitation using neuromuscular electrical muscle stimulation in a polytrauma patient. BMJ Case Rep. 2019 Dec 23;12(12):e232107.
- ↑ Zurkiya O. Quadrilateral space syndrome. Cardiovasc Diagn Ther. 2021 Oct;11(5):1112-1117.
- ↑ 6.0 6.1 Chow AL, Levidy MF, Luthringer M, Vasoya D, Ignatiuk A. Clinical Outcomes After Neurolysis for the Treatment of Peroneal Nerve Palsy: A Systematic Review and Meta-Analysis. Ann Plast Surg. 2021 Sep 1;87(3):316-323.
- ↑ S. Safavi-Abbasi, I. Feiz-Erfan, A.G. Shetter, Neurolysis, Editor(s): Michael J. Aminoff, Robert B. Daroff, Encyclopedia of the Neurological Sciences (Second Edition), Academic Press, 2014. Pages 406-407. Available from: http://www.sciencedirect.com/science/article/abs/pii/B9780123851574007697
- ↑ 8.0 8.1 Novak CB, von der Heyde RL. Rehabilitation of the upper extremity following nerve and tendon reconstruction: when and how. Semin Plast Surg. 2015 Feb;29(1):73-80.
- ↑ Gohritz A, Laengle G, Boesendorfer A, Gesslbauer B, Gstoettner C, Politikou O, Sturma A, Aszmann OC. Nerve Transfers for Brachial Plexus Reconstruction in Patients over 60 Years. J Pers Med. 2023 Apr 12;13(4):659.
