Types of injuries
The peripheral nervous system includes:
- cranial nerves,
- nerve roots,
- nerve plexuses
- and nerve trunks that connect the central nervous system with the executive organs (muscles, ligaments, skin, etc.).
Types of injuries
- Complete rupture of the nerve trunk is a severe injury in which the functions of the nerve trunk are completely lost.
- Partial rupture – part of the nerve fibers ruptures, and part may be damaged. Traction – that is, they are stretched.
- Sometimes the sprain can be completely intra-truncal and the outer sheaths of the nerve do not rupture, but the function is interrupted.
- Sometimes, a nerve contusion develops, which is characterized by loss of function but also rapid recovery.
- In some cases, a nerve trunk injury develops, when functions are restored more slowly or not restored at all.
Causes of peripheral nerve injuries
In some cases, the cause of the injury may be:
- gunshot wound
- or nerve damage during surgery, for example, when breaking a limb bone and performing osteosynthesis.
Symptoms
Symptoms that occur when the peripheral nervous system (PNS) is damaged depend on the level of damage and consist of the following main groups:
- Loss or weakening of movements in the muscles innervated by the affected part of the PNS (usually a nerve or group of nerves),
- Sensitivity disorders in the area of nerve innervation,
- Violation of vegetative and trophic functions in the area of nerve innervation.
Muscle strength and sensitivity
Skeletal muscle strength is assessed on a 6-point scale from 0 to 5,
- where 0 – lack of movement – plegia,
- and 5 is normal force.
Sensitivity is assessed on a three-point scale from 0 to 2,
- where 0 is complete lack of sensitivity,
- and 2 is normal sensitivity.
Injury diagnosis
In addition to clinical, the following diagnostic methods are used:
- Ultrasound of a damaged nerve allows you to obtain almost complete information about the condition of the nerve in the area of damage, up to the integrity of the fascicles, but does not allow you to assess the function of the nerve.
- Electroneuromyography – a method that helps assess nerve function – studies the conduction of nerve impulses along the nerve and can detect a block in such conduction, as well as evaluate quantitative conductivity indicators that help with assessing the effectiveness of treatment and predicting the outcome.
- MRI of the nerve – is rarely performed, but allows you to evaluate many indicators of the structure of the nerve.
- CT scan of the nerve – allows you to trace its integrity, involvement in the scar, and relationship with bone and other structures.
Surgical treatment
It is advisable to perform surgical treatment as soon as possible, unless there are contraindications. If there is an open wound, then immediately perform:
- suturing the wound,
- tendon restoration,
- blood vessels and nerves.
If there is no open wound, then it is possible to observe the recovery process along with restorative treatment for up to 2 months. If recovery does not begin during this period, then revision surgery is performed.
How long after the injury are surgeries effective?
As a rule, the effect can be achieved within a period of up to 24 months. After this period, irreversible changes occur in the muscles, which cannot be “started” even after the restoration of nerve conduction (reinnervation).
Some muscle groups, such as the facial muscles and large muscle bundles (biceps, triceps, quadriceps), are exceptions to this rule and can recover at a later date.
Surgical treatment of peripheral nervous system injuries
Preparation
An important requirement for peripheral nerve surgery is sufficient visibility during surgery, it is important to see all anatomical structures (nerves, muscles, tendons) during surgery. This allows the surgeon to inspect the extent of nerve damage and freely perform all necessary manipulations during surgery.
The neurosurgical department of the Kherson Regional Clinical Hospital has an operating microscope. All operations on peripheral nerves are performed under a microscope with minimal trauma to the surrounding tissues.
Features
In case of acute trauma and the presence of wounds, primary surgical treatment of the wound is performed with nerve revision; if the nerves are damaged, they are sutured.
Operation
Neurolysis of the nerve, plexus – freeing the nerve from its compromising scar tissue, removing foreign bodies if present.
The operation is performed under local anesthesia under a microscope. The injured nerve is separated from its compromised tissues with maximum care.
If the integrity of the nerve is not compromised, an electrical stimulator is placed directly on the nerve and the patient undergoes nerve stimulation for 3 weeks.
Neurorhaphy – when a nerve is torn, after its ends are separated from the scars, the nerve is sutured under a microscope. If there is a large gap between the separated ends of the nerve, when they cannot be compared, the missing area is prosthetically replaced with the body’s own superficial nerves, which allows its integrity to be restored.
The effectiveness of surgical treatment is highest in the first 4 months after the injury.
Rehabilitation period
After surgical treatment, the patient needs to visit a doctor 1 month after the operation to determine the tactics of further treatment.
The neurosurgical department has all the necessary components for the successful treatment of peripheral nervous system injuries: microinstruments.
Excellent operating microscope from the German manufacturer Karl Zeiss. Highly qualified staff who know all the techniques of microsurgery of peripheral nerves.
Treatment protocols that meet the most modern achievements of neurosurgical science in Europe and the world.
Neurosurgeons Nazarenko O.S. and Dmytruk V.S.
