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Nerve Injuries

Nerve injuries can happen under surgical conditions in which the surgeon accidentally cuts a major nerve. It can also happen to a lesser extent when nurses inject medications too close to a large nerve.

Peripheral nerves can occur through several types of traumas. These include:

• Laceration during surgery
• A focal contusion
• Stretch or traction injury
• Injection injury
• Electrical injury
• Gunshot wound

When nerves are injured, several different types of serious complications to nerve injuries that have to be treated:

• Brachial plexus injury—a severe injury to nerves in the area of the armpit and can affect sensation of the arm.
• Foot drop—this is injury to the peroneal nerve and sciatic nerve.
• Meralgia paresthetica—this is an injury to the femoral cutaneous nerve and femoral nerve which can happen in things like passing catheters in cardiac procedures.
• Spinal accessory nerve which is an injury to the cranial nerve and spinal accessory nerve.

The injury to the nerve or nerves is classified into a classification system such as the Sunderland Classification System. It divides injuries to nerves into five different aspects. These different parts include:

1. First degree injury—this is a reversible and local nerve blockage that doesn’t require any surgery. It takes hours to weeks in order to reverse.
2. Second degree injury—the axons of the nerve are disturbed as discovered on nerve function testing. You usually don’t need surgery.
3. Third degree injury—Axons and supporting structures are disturbed. The repair may involve simple cleaning or possibly grafting, which is more extensive.
4. Fourth degree injury—There is damage to axons and to the surrounding tissues. Regeneration is prevented because of scarring. No electrical activity goes through the injured nerve. Surgery and grafting are a necessity.
5. Fifth degree injury—these are found in lacerations or stretch injuries that are severe. There is division of the nerve that can only be repaired by doing surgery on the nerve.

There is diagnostic testing that can be done to find out how severe a nerve injury is, an electromyogram or EMG is done along with a nerve conduction velocity test or NCV. Some other tests that might be helpful are a CT scan of the affected area, an MRI, or an MRI Neurography exam.

What are some excellent nerve treatments that are nonsurgical? Nonsurgical treatments for nerve injuries include:

• Massage therapy, which can stimulate healing
• Acupuncture, which can increase nerve functioning
• Certain medications
• Weight loss
• Orthotic use
• Physical therapy

If surgery is required for the management of nerve injuries, very often the broken nerve ends are reunited so that they can begin to come together microscopically. Peripheral nerves often need many months to restore themselves into a unified nerve that functions from one end to the other.

If a nerve fails to connect, the end result is a muscle failure and atrophy or a loss of skin sensation. Some people experience pain in the affected nerve area. When a damaged nerve is approximated, the axons microscopically connect with the distal axons so that function can be restored. Nerves have a natural ability to repair themselves, initially by sprouting regenerative nerve units. They will travel down the distal area in order to make a connection with a distal nerve. A motor nerve should connect with a distal motor nerve and a sensory nerve should connect to another sensory nerve. If the connection cannot be made then there will be loss of function. When nerves regenerate, they do so at a rate of 1 inch per month. Nerves that are sensory have good physical functioning more than nerves that have motor functioning.