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Seminars in Neurosurgery 2001; 12(1): 019-028
DOI: 10.1055/s-2001-12996
Copyright © 2001 by Thieme Medical Publishers, Inc., 333 Seventh Avenue, New York, NY 10001, USA. Tel.: +1(212) 584-4662

Contemporary Management of Peripheral Nerve Trauma

John K. Ratliff1 , Line Jacques2 , David G. Kline1
  • 1Department of Neurosurgery, Louisiana State University, New Orleans, Louisiana
  • 2Montreal Neurological Institute/McGill University, Montreal, Quebec.
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Publication History

Publication Date:
31 December 2001 (online)

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ABSTRACT

Peripheral nerve injury remains a significant cause of disability. Injuries often occur in young, otherwise healthy individuals. Currently, civilians compose the majority of evaluated cases, but significant injuries continue to occur during wartime. Some lesions recover spontaneously and others are helped by surgical repair; still others have persistent neurologic deficits even with optimal management. The evolution of imaging, predominantly the widespread availability of magnetic resonance imaging (MRI) and development of surface coils specific for nerve, may improve preoperative assessment of nerve damage. Intraoperative electrophysiologic assessment of nerve lesions is another advance that continues to evolve. Advances in neurotrophin physiology and better understanding of nerve regeneration have yet to yield significant improvements in repair but offer promise for the future. We review the contemporary management of peripheral nerve injury, focusing on treatment paradigms developed at the Louisiana State University Health Science Center, but also highlighting promising areas of research. The foundations for management of traumatic nerve injury remain constant. These include a thorough history and physical examination, appropriate radiographic assessment, electrophysiology assessment, and operative exploration when indicated.

KEYWORD

Peripheral nerve - nerve injury - nerve action potential

REFERENCES

  • 1 Kline D. Civilian gunshot wounds to the brachial plexus.  J Neurosurg . 1989;  70 166-174
    CrossrefPubMedGoogle Scholar
  • 2 Gousheh J. The treatment of war injuries of the brachial plexus.  J Hand Surg (Am) . 1995;  20 S68-76
    PubMedGoogle Scholar
  • 3 Barisc N, Perovic D, Mitrovic Z. Assessment of war and accidental nerve injuries in children.  Pediatric Neurol . 1999;  21 450-455
    PubMedGoogle Scholar
  • 4 Frostick S, Yin Q, Kemp G J. Schwann cells, neurotrophic factors, and peripheral nerve regeneration.  Microsurgery . 1998;  18 397-405
    Google Scholar
  • 5 Howe F, Filler A G, Bell B A, Griffiths J R. Magnetic resonance neurography.  Magn Reson in Medicine . 1992;  28 328-338
    PubMedGoogle Scholar
  • 6 Filler A, Kliot M, Howe F A. Application of magnetic resonance neurography in the evaluation of patients with peripheral nerve pathology.  J Neurosurg . 1996;  85 299-309
    CrossrefPubMedGoogle Scholar
  • 7 Kline D, Hudson A R, Zager E. Selection and preoperative work-up for peripheral nerve surgery.  Clin Neurosurg . 1992;  38 8-35
    PubMedGoogle Scholar
  • 8 Kline D. Timing for exploration of nerve lesions and evaluation of the neuroma-in-continuity.  Clin Orthop and Related Research . 1982;  163 42-49
    PubMedGoogle Scholar
  • 9 Kline D, Hudson A R. Nerve injuries: operative results for major nerve injuries, entrapments, and tumors.  Philadelphia: WB Saunders; 1995
    Google Scholar
  • 10 Grant G, Goodkin R, Kliot M. Evaluation and surgical management of peripheral nerve problems.  Neurosurgery . 1999;  44 825-840
    CrossrefPubMedGoogle Scholar
  • 11 Vanderhooft E. Functional outcomes of nerve grafts for the upper and lower extremities.  Hand Clinics . 2000;  16 93-104
    PubMedGoogle Scholar
  • 12 Seddon H. Three types of nerve injury.  Brain . 1943;  66 237-288
    CrossrefPubMedGoogle Scholar
  • 13 Sunderland S. Nerve Injuries and Their Repair: A Critical Appraisal.  Edinburgh: Churchill Livingstone; 1991
    Google Scholar
  • 14 Mackinnon S, Dellon A L. Surgery of the Peripheral Nerve.  New York: Thieme; 1988
    Google Scholar
  • 15 Carvalho G, Nikkhah G, Matthies C. Diagnosis of root avulsions in traumatic brachial plexus injuries: value of computerized tomography myelography and magnetic resonance imaging.  J Neurosurg . 1997;  86 69-76
    CrossrefPubMedGoogle Scholar
  • 16 Roger B, Travers V, Laval-Jeantet M. Imaging of posttraumatic brachial plexus injury.  Clin Orthopaedics . 1988;  237 57-61
    PubMedGoogle Scholar
  • 17 Skalpe I. Cervical myelography (letter).  Radiology . 1990;  177 590
    PubMedGoogle Scholar
  • 18 Hems T, Birch R, Carlstedt T. The role of magnetic resonance imaging in the management of traction injuries to the adult brachial plexus.  J Hand Surg (British) . 1999;  24B 550-555
    PubMedGoogle Scholar
  • 19 Wysoki M, Koenigsberg R A, Camras L. Magnetic resonance imaging of traumatic cervical nerve injuries.  J Neuroimaging . 1998;  8 38-41
    PubMedGoogle Scholar
  • 20 Kline D, Hudson A R. Diagnosis of root avulsions (letter).  J Neurosurg . 1997;  87 483
    PubMedGoogle Scholar
  • 21 Parry G. Electrodiagnostic studies in the evaluation of peripheral nerve and brachial plexus lesions.  Neurologic Clin . 1992;  10 921-934
    PubMedGoogle Scholar
  • 22 Matthies C, Carvalho G A, Penkert G. Diagnosis of root avulsions (letter).  J Neurosurg . 1997;  87 484
    PubMedGoogle Scholar
  • 23 Maravilla K, Bowen B C. Imaging of the peripheral nervous system: evaluation of peripheral neuropathy and plexopathy.  Am J Neuroradiol . 1998;  19 1011-1023
    PubMedGoogle Scholar
  • 24 Jarvik J, Kliot M, Maravilla K R. MR nerve imaging of the wrist and hand.  Hand Clinics . 2000;  16 13-24
    PubMedGoogle Scholar
  • 25 Dubuisson A, Kline D G. Indications for peripheral nerve and brachial plexus surgery.  Neurologic Clinics . 1992;  10 935-951
    PubMedGoogle Scholar
  • 26 Manord J, Garrard C L, Kline D G. Management of severe proximal vascular and neural injury of the upper extremity.  J Vasc Surg . 1998;  27 43-49
    PubMedGoogle Scholar
  • 27 Omer G, Spinner M, Van Beek L A. Management of Peripheral Nerve Problems.  Philadelphia: WB Saunders; 1998
    Google Scholar
  • 28 Spinner R, Kline D G. Surgery for peripheral nerve and other brachial plexus injuries or other nerve lesions.  Muscle and Nerve . 2000;  23 680-695
    PubMedGoogle Scholar
  • 29 Perlmutter G. Axillary nerve injury.  Clin Orthop and Related Research . 1999;  368 28-36
    PubMedGoogle Scholar
  • 30 Friedman A, Nunley II A J, Urbaniak J R, Goldner R D. Repair of isolated axillary nerve lesions after infraclavicular brachial plexus injuries: case reports.  Neurosurgery . 1990;  27 403-407
    CrossrefPubMedGoogle Scholar
  • 31 Kim D, Tiel R, Kline D G. Surgical management and results of radial nerve lesions. American Association of Neurological Surgeons Annual Meeting San Francisco: April 10 2000
    Google Scholar
  • 32 Cravens G, Kline D G. Posterior interosseous nerve palsies.  Neurosurgery . 1990;  27 397-402
    PubMedGoogle Scholar
  • 33 Kline D, Kim D, Midha R. Management and results of sciatic nerve injuries: a 24-year experience.  J Neurosurgery . 1998;  89 13-23
    PubMedGoogle Scholar
  • 34 Kim D, Tiel R, Kline D G. Surgical management and results of tibial nerve lesions. American Association of Neurological Surgeons Annual Meeting. San Francisco; April 10, 2000
    Google Scholar
  • 35 Kim D, Kline D G. Management and results of peroneal nerve lesions.  Neurosurgery . 1996;  39 312-320
    CrossrefPubMedGoogle Scholar
  • 36 Kim D, Kline D G. Surgical outcome for intra- and extrapelvic femoral nerve lesions.  J Neurosurgery . 1995;  83 783-790
    PubMedGoogle Scholar
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