Evaluation of the Physical Treatment Success in Patients with Peripheral Nerve Injury Caused by Firearm

Abstract

Background: All wars bring high incidence of patients with peripheral nerve injuries, and many of today's knowledge about degeneration, regeneration and surgical treatment in this casuistry come from the period of the global world conflict. Such injuries do not endanger life, but the function of the extremities is threatened, which manifests itself in motor and sensory outbursts, as well as negative psychological implications. Objective: The aims of this article were: a) To present the method of monitoring physical treatment in a patient with a peripheral nerve injury; b) To perform a quantitative analysis of nerve lesions caused by firearms (n = 445);; c) To present the effects of physical treatment for this condition;; d) To analyze the time interval from injury to healing (n = 220);; e) Determine the time from injury until the surgery. Results: Anatomical disruption of axons with complete Waler degeneration. The connective tissue network remains intact and the endoneurium can guide the regenerated nerve fibers to their destination. Spontaneous functional recovery can be expected in 12 to 18 months. Clinical evaluation shows a deficit in the innervation area of damaged axons with muscle atrophy and loss of sensitivity. Nerve recovery can be inhibited by scar formations at the site of injury. Complete interruption of the nerve. Functional recovery is not possible without surgical intervention. Paralysis of mm. atrophy, anesthesia and atrophic skin changes are visible. Conclusion: Rehabilitation is a delicate problem and requires long-term treatment and multidisciplinary cooperation, and is carried out in accordance with the principles of peripheral nerve repair. Factors that facilitate successful regeneration are: a) Pre and post-operative physical treatment; b) Younger age; c) Shorter time since injury (<6 months); d) More distal level of the lesion; e) Absence of factors complicating the injury (infection); and f) The first signs of nerve recovery are the return of sweating and pain.