Unrecognized peripheral nerve lesions in a traumatic brain injury patient (original) (raw)
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Journal of Forensic and Legal Medicine, 2017
Background: Peripheral nerve injuries (PNI) are relatively common pathologies in clinical practice. PNIs are rare in the lower extremity but have worse prognosis than those in the upper extremity. Electrodiagnostic studies could help better understanding PNIs. In this study, we aimed to evaluate the distribution of lower extremity PNI in traumatic patients in northwest of Iran. Methods: In this prospective study, 74 patients (62 male and 12 female with mean age of 38.39 ± 14.42 years) with possible lower or lumbosacral peripheral nerve injury were studied. Patients' demographic information and physical examination findings were recorded. Electrodiagnostic investigations including electromyography and Nerve Conduction Study were performed for all subjects. Results: Common chief complaints were pain and weakness. Impairment in the sensory function was present in 59.5% and muscle force reduction in 47.3%. PNIs were present in 23.0% and mostly were severe. Injuries in sciatic nerve were the most common PNIs (16.2%). Electrodiagnostic studies showed radiculopathy in 48.7% and plexopathy in 8.10% of cases. In 52 patients (70.3%), the physical examination findings were compatible with Electrodiagnostic studies. Conclusion: Not all patients presenting with traumatic injuries have lower extremity PNIs. Due to the nature of the trauma and the anatomical course of the nerves, sciatic nerve is more susceptible to traumatic injuries.
Traumatic peripheral nerve injuries: a classification proposal
Journal of Orthopaedics and Traumatology
Background Peripheral nerve injuries (PNIs) include several conditions in which one or more peripheral nerves are damaged. Trauma is one of the most common causes of PNIs and young people are particularly affected. They have a significant impact on patients’ quality of life and on the healthcare system, while timing and type of surgical treatment are of the utmost importance to guarantee the most favorable functional recovery. To date, several different classifications of PNIs have been proposed, most of them focusing on just one or few aspects of these complex conditions, such as type of injury, anatomic situation, or prognostic factors. Current classifications do not enable us to have a complete view of this pathology, which includes diagnosis, treatment choice, and possible outcomes. This fragmentation sometimes leads to an ambiguous definition of PNIs and the impossibility of exchanging crucial information between different physicians and healthcare structures, which can create ...
Boletín de la Asociación Médica de Puerto Rico
Describe the etiology and frequency of traumatic peripheral nerve injuries (TPNI) in the electrodiagnostic laboratory of a tertiary care hospital. The charts of patients who underwent an electrodiagnostic study for a TPNI were revised. The main outcome measure was the frequency of each injury by anatomic location, involved nerve, mechanism, and severity. 146 charts were included for a total of 163 injured nerves; 109 (74.7%) males and 37 (25.3%) females. The mean age was 33.6 years. The facial nerve and the brachial plexus followed by the ulnar nerve were more frequently involved. The ulnar, sciatic, median, radial nerve, and the lumbosacral plexus were more commonly injured by gunshot wounds, the brachial plexus by motor vehicle accidents, and the facial nerve by iatrogenic causes. The majority of the injuries were incomplete or partial (84.2% were incomplete and 15.8% complete injuries). TPNIs can lead to significant disability, but further investigation is needed to better unders...
Plastic and Aesthetic Research, 2015
Peripheral nerve injuries are a heterogeneous group of lesions that may occurs secondary to various causes. Several different classifications have been used to describe the pathophysiological mechanisms leading to the clinical deficit, from simple and reversible compression-induced demyelination, to complete transection of nerve axons. Neurophysiological data localize, quantify, and qualify (demyelination vs. axonal loss) the clinical and subclinical deficits. High-resolution ultrasound can demonstrate the morphological extent of nerve damage, fascicular echotexture (epineurium vs. perineurium, focal alteration of the cross-section of the nerve, any neuromas, etc.), and the surrounding tissues. High field magnetic resonance imaging provides high contrast neurography by fat suppression sequences and shows structural connectivity through the use of diffusion-weighted sequences. The aim of this review is to provide clinical guidelines for the diagnosis of nerve injuries, and the rationale for instrumental evaluation in the preoperative and postoperative periods. While history and clinical approach guide neurophysiological examination, nerve conduction and electromyography studies provide functional information on conduction slowing and denervation to assist in monitoring the onset of re-innervation. High-resolution nerve imaging complements neurophysiological data and allows direct visualization of the nerve injury while providing insight into its cause and facilitating surgical treatment planning. Indications and limits of each instrumental examination are discussed.
Reappraisal of Clinical Deficits Following High Median Nerve Injuries
The Journal of Hand Surgery, 2016
Purpose To describe clinically apparent motor and sensory deficits in a cohort of 11 patients with isolated injury of the median nerve above the elbow and compare them against similar cases reported in the literature. Method Eleven patients of mean age 30 years (SD AE 14 years; 6 males, 5 females) were examined a mean of 21 weeks (SD AE 16 weeks) after an isolated high median nerve injury. Pronation, wrist flexion, and finger flexion range of motion and strength (British Medical Research Council scale) were evaluated. Grasp and lateral pinch strength were assessed bilaterally using a dynamometer. Thumb opposition was evaluated using the Kapandji score. Sensory impairment was considered significant when there was no perception of a 2.0-g Semmes-Weinstein filament. Results Pronation was largely preserved in all patients to a mean range of motion of 52 (SD AE 13), and pronation strength was M4 in 10 of 11 patients. Wrist flexion scored M5 in all patients. Thumb and index distal interphalangeal joint flexion were absent in all patients. In all patients, middle, ring, and little finger flexion was complete and scored M5. Thumb function scored above 5 in all patients, averaging 7.5 (SD AE 1.2) on the Kapandji scale. Grasp and pinch strength were 43% (SD AE 12%) and 36% (SD AE 11%) of the contralateral (normal) limb, respectively. Impaired sensation of a 2.0-g monofilament was found only in the palmar region over the middle and distal phalanges of the index and middle fingers and the distal phalanx of the thumb. Conclusions Noteworthy discrepancies were identified between the clinical motor and sensory deficits described in the literature and those observed in our patients. Clinical relevance In most patients with a high median nerve injury, only thumb and index flexion and palmar sensation warrant surgical reconstruction. Decreased grasp and pinch strength was a major finding that should also be addressed by surgery.
Journal of Evolution of Medical and Dental Sciences, 2018
BACKGROUND Clinical disability or inability to use full function of upper limb and EMG can be a guide to assess probability of severity of pathological damage. Pathologies like neuropraxia, axonotmesis and neurotmesis have varied disability presentation and EMG findings. Hence, disability scores and EMG can correlate well with peripheral nerve pathologies. The purpose of this study is evaluation of peripheral nerve pathologies using disability score and electromyographic (EMG) findings. MATERIALS AND METHODS Study design was hospital-based cross-sectional study, which was conducted in outpatient medical and surgical department of MY Hospital, Indore, in patients of upper limb peripheral nerve pathologies with intention of identifying the selected epidemiological variables along with measurement of quick DASH (Disabilities of the Arm, Shoulder and Hand score) and analysing the electromyographic findings. Study was conducted over a period of one year from January 2015 to December 2015. RESULTS There were 51 patients (mean age 36; SD, 11.7 years) with peripheral nerve pathologies (n= 39) and traumatic injuries (n= 12). Female-to-male ratio was 2.18: 1. Mean quick DASH score was 61.35 (SD, 20.5) of 100. For traumatic patients mean quick DASH score was 83.25 (SD, 13.13) and for non-traumatic patients it was 57.41 (SD, 14.65). Electromyographic parameter of voluntary muscle activity and recruitment were absent in all of the twelve traumatic injury patients and it was present in other thirty-nine non-traumatic neuropathies. Electromyographic finding of spontaneous potential was observed in all the 51 patients. CONCLUSION High quick DASH scores are found in traumatic injury patients. In non-traumatic neuropathies, the quick DASH scores are quite disabling but not that high. Electromyographic findings in traumatic injuries are suggestive of neurotmesis. Finding of spontaneous activity in all the patients suggest active denervation (axonotmesis or neurotmesis) and it warrants aggressive treatment.
Traumatic injuries of peripheral nerves: a review with emphasis on surgical indication
Arquivos de neuro-psiquiatria, 2013
Traumatic peripheral nerve injury is a dramatic condition present in many of the injuries to the upper and lower extremities. An understanding of its physiopathology and selection of a suitable time for surgery are necessary for proper treatment of this challenging disorder. This article reviews the physiopathology of traumatic peripheral nerve injury, considers the most used classification, and discusses the main aspects of surgical timing and treatment of such a condition.