Peripheral Nerve Injury 957

synonyms:Peripheral nerve injury

Peripheral Nerve Injury ICD-9

• 957 Injury to other and unspecified nerves
• 907.9 Late effect of injury to other and unspecified nerve

Peripheral Nerve Injury Etiology / Epidemiology / Natural History

Peripheral Nerve Injury Anatomy

• Acetylcholinesterase is present in myelinated motor axons and many unmyelinated axons but not in sensory axons. Carbonic anhydrase is in myelin and axoplasm of sensory axons.

Peripheral Nerve Injury Clinical Evaluation

Peripheral Nerve Injury Xray / Diagnositc Tests

Peripheral Nerve Injury Classification / Treatment

• Seddon Classification
  --Neuropraxia: reversible aberration in axonal function. May have focal demyelination. Complete recovery occurs nearly immediately up to 2 weeks.
  --Axonotmesis: axon and myelin sheath disrupted; epineurium remains intact. Wallerian degeneration occurs distal to the lesion. Functional recovery may be incomplete.
  --Neurotmesis: complete disruption of the nerve. Rare in athletes. Recovery generally does not occur.
• Primary repair = within several hours of injury indicated for sharp transections. Delayed primary repair = 5-7 days indicated for avulsion/crush injuries to allow determination of zone of injury. Secondary repair = >7days from injury.

Peripheral Nerve Repair

• Repair must be tension free. Consider interpositional nerve grafting if tension is noted.
• Graft options: sural, anterior brach of the medial antebrachial cutaneous, lateral antebrachial, terminal branches of the posterior interosseous nerve.
• No benefit has been demonstrated between epineural or grouped fascicular repairs or using fascicle matching techniques
• Consider neuroflex tube augmentation of repairs.

Peripheral Nerve Injury Associated Injuries / Differential Diagnosis

Peripheral Nerve Injury Complications

Peripheral Nerve Injury Follow-up Care

Peripheral Nerve Injury Review References

• Lee SK, JAAOS 2000;8:243
• Mohler LR, JAAOS 2006;14:32
• Rowshan K, Op Tech Orthopedics 2004;14:163