Classification Of Nerve Injuries Research Articles

Cervical Transforaminal Epidural Injection in the Management of a Stinger

A “stinger,” otherwise known as a “burner,” is a transient, reversible peripheral nerve injury of the upper limb caused by injury to the cervical spine and shoulder. This injury usually occurs during participation in contact sports [1-3]. Stingers are considered to be underreported by athletes and are most common in American-style football, hockey, gymnastics, and wrestling [4]. In a study of collegiate American-style football players, Levitz et al [5] reported that stingers occur in 50%-65% of these athletes during the course of their career; they also reported high rates of recurrence. Mechanisms of injury include traction, compression, and direct blows [4,6-9]. Traction injuries result from ipsilateral shoulder depression and contralateral neck flexion, effectively resulting in traction on the nerve root and/or brachial plexus. At the high school level, football players are more likely to have traction injuries. Conversely, compression injuries are more likely sustained at the collegiate and professional levels [10]. Compression injuries of the nerve root stem from a combination of forced hyperextension with ipsilateral rotation and lateral flexion leading to transient neuroforaminal narrowing. Finally, a direct blow to the supraclavicular region (Erb point), where the brachial plexus is most superficial, can result in direct trauma to the plexus. Most stingers, according to the Seddon classification scheme, are characterized as firstor second-degree peripheral nerve injuries, which refer to neurapraxia (demyelination) or axonotmesis (axonal loss), respectively. A third-degree injury, or neurotmesis (complete nerve transection), is not considered within the spectrum of this disorder [11,12]. Because tackling and blocking are the two most common mechanisms of stingers, defensive backs and offensive linemen are most susceptible [10]. Symptoms appear immediately after contact [1] and generally affect the upper trunk of the brachial plexus or C5/C6 erve roots [6-8,13-15]. The primary symptom is burning pain referring to the upper limb, hich may be accompanied by weakness, numbness, and paresthesias [1,16]. Symptoms typically do not last more than 24 hours [2]. A wide range of clinical courses have been described after a stinger injury, ranging from full recovery in seconds or hours to the development of a chronic syndrome [1,5]. The distribution of weakness is dependent on the source of the nerve injury, but whether it is the root (C5 or C6) or upper trunk of the brachial plexus, the most common pattern of muscle weakness involves the deltoid, supraspinatus, and/or infraspinatus for several weeks after the injury [17]. Conflicting views exist regarding the location of the neurological lesion [13]. Some authors who included an electrodiagnostic evaluation in their studies reported a greater incidence of brachial plexus involvement [8,14,15,18]. However, Slipman et al [19] demonstrated that diagnostic cervical selective nerve root blocks frequently provoke symptoms outside the classic dermatomal distribution in nonathletes. Thus it is plausible that injury to a single nerve root can produce a more circumferential pattern of symptoms in the upper limb [20]. Several factors suggest that most stingers are caused by cervical nerve root injury [5,21]. It has been shown that there is a statistically significant 10%-13% decrease in neuroforaminal diameter when the neck is positioned in 20°-30° of extension, as is common during a stinger injury [22]. Anatomically, the cervical nerve roots appear to be more vulnerable to injury than the brachial plexus because of their orientation and

Vision-threatening retinal abnormalities in chronic kidney disease stages 3 to 5.

Retinal abnormalities are common in inherited and acquired renal disease. This study determined the prevalence of retinal abnormalities in chronic kidney disease (CKD) stages 3 to 5. One hundred fifty patients with CKD stages 3 to 5 and 150 age- and gender-matched hospital patients with CKD stages 1 to 2 underwent bilateral retinal photography. These images were reviewed for incidental abnormalities, microvascular (Wong and Mitchell classification) and diabetic retinopathy (Airlie House criteria), and macular degeneration (Seddon classification). Three (2%) patients with CKD stages 3 to 5 had retinal features characteristic of inherited renal disease (atrophy in Myopathy, Encephalopathy, Lactic Acidosis, Stroke-like episodes [MELAS] syndrome; and 2 with drusen in dense deposit disease). Fifty-nine (39%) patients had moderate-severe microvascular retinopathy (hemorrhages, exudates, etc.) compared with 19 (13%) with CKD stages 1 to 2. Forty-one (28%) had moderate-severe diabetic retinopathy (microaneurysms, exudates, etc.) compared with 16 (11%) with CKD stages 1 to 2. Ten (7%) had severe macular degeneration (geographic atrophy, hemorrhage, exudates, membranes) compared with one (1%) with CKD stages 1 to 2. Renal failure was an independent risk factor for microvascular retinopathy, diabetic retinopathy, and macular degeneration. Eleven (7.3%) patients with renal failure and one (0.7%) with CKD stages 1 to 2 had previously unrecognized vision-threatening retinal abnormalities that required immediate ophthalmologic attention. Retinal abnormalities are common in CKD stages 3 to 5, and are more severe and more likely to threaten vision than in hospital patients with CKD stages 1 to 2.

Biomedical Engineering Strategies for Peripheral Nerve Repair: Surgical Applications, State of the Art, and Future Challenges

Damage to the peripheral nervous system is surprisingly common and occurs primarily from trauma or a complication of surgery. Although recovery of nerve function occurs in many mild injuries, outcomes are often unsatisfactory following severe trauma. Nerve repair and regeneration presents unique clinical challenges and opportunities, and substantial contributions can be made through the informed application of biomedical engineering strategies. This article reviews the clinical presentations and classification of nerve injuries, in addition to the state of the art for surgical decision-making and repair strategies. This discussion presents specific challenges that must be addressed to realistically improve the treatment of nerve injuries and promote widespread recovery. In particular, nerve defects a few centimeters in length use a sensory nerve autograft as the standard technique; however, this approach is limited by the availability of donor nerve and comorbidity associated with additional surgery. Moreover, we currently have an inadequate ability to noninvasively assess the degree of nerve injury and to track axonal regeneration. As a result, wait-and-see surgical decisions can lead to undesirable and less successful "delayed" repair procedures. In this fight for time, degeneration of the distal nerve support structure and target progresses, ultimately blunting complete functional recovery. Thus, the most pressing challenges in peripheral nerve repair include the development of tissue-engineered nerve grafts that match or exceed the performance of autografts, the ability to noninvasively assess nerve damage and track axonal regeneration, and approaches to maintain the efficacy of the distal pathway and targets during the regenerative process. Biomedical engineering strategies can address these issues to substantially contribute at both the basic and applied levels, improving surgical management and functional recovery following severe peripheral nerve injury.

Neural outcomes after plasma knife dissection: A pathologic study and clinical correlation

The initial aim was to determine the rate of pathologic tissue damage when dissecting the rat sciatic nerve with either bipolar forceps or low-temperature tripolar plasma knife. The second aim was to determine the safety and effectiveness of the plasma knife during parotid surgery. A prospective, randomized, single-blind study was performed on 40 rat sciatic nerves dissected by either bipolar electrocautery with a cold knife or a plasma knife. Dissected nerves were excised and submitted blindly to pathology for analysis of nerve injury. The degree of nerve trauma was graded by the Carlander nerve injury classification. Separately, a review was performed on the facial nerve outcomes of 30 patients who underwent plasma knife parotidectomy. No thermal or neural injury was noted in the 40 rat sciatic nerves dissected by either bipolar electrocautery or plasma knife (p = 1.0). Two plasma knife-dissected nerves (8%) demonstrated significant numbers of mast cells in the perineural soft tissue. In 30 patients undergoing plasma knife-parotidectomy, 10 (33%) had mild weakness of 1 or 2 preserved facial nerve branch postoperatively (House-Brackmann 2) that resolved within 1 month, whereas 2 (7%) had visible weakness in 1 branch (HB 3) that normalized after 3 months of follow-up. Plasma knife nerve dissection seems to be a safe and effective alternative to conventional methods. This technique may confer some advantages over conventional methods with the ability to simultaneously cut and coagulate tissue with minimal thermal spread and electrical stimulation of adjacent neural structures.

Investigation of infraorbital nerve injury following zygomaticomaxillary complex fractures

The aim of this study was to investigate the severity of infraorbital nerve injury following zygomaticomaxillary complex fractures and to estimate the treatment methods facilitating its functional recovery. A total of 478 patients with unilateral zygomaticomaxillary complex fractures were treated. Infraorbital nerve sensory disturbances were diagnosed in 64.4% of the patients. Injury of the infraorbital nerve was expressed as asymmetry index, which was calculated as a ratio between the affected side and the intact side electric pain detection thresholds at the innervation zone skin before treatment and 14 days, 1, 3, 6 and 12 months postoperatively. A mean asymmetry index of 0.6 +/- 0.03 and 1.9 +/- 0.5 was registered for 57 (11.9%) patients with hyperalgesia and for 251 (52.5%) patients with hypoalgesia, respectively. As a result of retrospective analysis of infraorbital nerve sensory disturbances and its functional recovery, infraorbital nerve injury severity was classified as mild, moderate and severe. It was found that the dynamics and outcome of the functional infraorbital nerve recovery depend on the severity of the injury and the presence of infraorbital canal damage. Function was completely recovered within 3 months after treatment in cases with mild nerve injury. In moderate cases, complete recovery was seen within 6 months and in 34.6% of the severe cases, within a 12-month period after treatment when infraorbital nerve decompression was performed according to the stated indication. Treatment based on infraorbital nerve injury classification offers a better prognosis for complete recovery of the infraorbital nerve function.

Clinics in neurology and neurosurgery of sport: peripheral nerve injury

Peripheral nerve injuries are not uncommon in sports. Typically, these are associated with orthopaedic injury (eg, axillary nerve injury with glenohumeral joint dislocation) rather than the transection or gunshot-type injuries...

Rapid nerve recovery following decompression - a case of post-traumatic axonamonosis

We report a humeral fracture associated with complete radial nerve palsy, where immediate nerve recovery followed decompression. This uncommon type of nerve lesion is referred to as axonamonosis and is not included in the traditional Seddon nerve injury classification.

Clinical evaluation of ulnar nerve repair at wrist level.

In this study, the results of ulnar nerve repair were analyzed. The relation between the functional outcome scores and clinical findings were investigated to find out whether any clinical finding could be predictive of the outcome. Seventeen patients who underwent ulnar nerve repair formed the study group. Average follow-up lasted 45.5 months (range 39-48 months), and average age of the study group was 31.7 years (range 26-42 years). The same operative technique was applied to all patients by one of the authors (HG). Follow-up checks were done at 3, 6, and 12 months postoperatively. The patients who did not attend the last follow-up were excluded from the study group. The Seddon classification was used as the functional scoring system. Wound healing, Tinel sign, interosseous atrophy, atrophy of the first web space, clawing, and protective sensation were the clinical findings examined at the follow-ups. Wound healing was classified as either normal scar formation or hypertrophic scar-keloid (HsC) formation. Good results in 4 and fair results in 13 were obtained according to the Seddon classification. Statistically, there was no difference between the clinical findings at the 3, 6, and 12 month follow-ups. Presence of HsC and clawing can be regarded as a predictive sign for fair results in nerve repairs.

Peripheral Nerve Injury

Management of the patient with a peripheral nerve injury should be based on a sound knowledge of the underlying anatomy, nerve injury classification, pathophysiology and medical management. This review of the literature addresses those topics with a depth and breadth appropriate for the physiotherapist. Specifically, this article will cover current tends in surgical management and nerve growth enhancement. A review of research relevant to rehabilitation concepts that illustrates the role of physiotherapist in the management of nerve injuries and repairs will also be discussed. This role includes post-injury rehabilitation, post-operative rehabilitation and evaluation of recovery. Additionally, the paucity of physiotherapy-generated research devoted to outcomes of these injuries demonstrates the need for continued work in this area.

History of Peripheral Nerve Surgery Techniques

The nineteenth century witnessed significant discoveries in the understanding of the peripheral nerve response to injury. Unfortunately, these discoveries were not widely accepted and several physiologically implausible nerve repair procedures survived into the first decades of the twentieth century. The surgical experience in World War I winnowed out most of these unsound techniques and laid the foundations for modern direct nerve repair. The surgical experience of World War II led to a rational classification of nerve injuries and refined the timing for surgical intervention. Major postwar developments that led to the modern era include improved nerve grafting techniques, intraoperative nerve action potential recording, and strategies for the repair of brachial plexus lesions.

Estudo comparativo da acomodação residual após instilação de colírios de tropicamida a 1%, ciclopentolato a 1% e associação de tropicamida a 1% + ciclopentolato a 1%

Objetivo:Avaliar a acomodação residual após a instilação de duas drogas cicloplégicas, o ciclopentolato a 1% e a tropicamida a 1% e a associação entre elas. Material e Método: Selecionamos pacientes de 15 a 25 anos, com íris grau 4 e 5 pela classificação de Seddon e sem nenhum tipo de doença ocular, que procuraram de maneira espontânea o ambulatório de Oftalmologia da Santa Casa de São Paulo no período de outubro de 1997 a setembro de 1998.Os 46 pacientes foram submetidos a três exames oftalmológicos completos, em que se testava o potencial de acomodação monocularmente, após a instilação de tropicamida a 1%, com tempo de espera de 20 minutos, ciclopentolato a 1% com tempo de espera de 40 minutos e tropicamida a 1% + ciclopentolato a 1% com intervalo entre as drogas de 5 minutos e com latência de 30 minutos. O intervalo entre os exames era de no mínimo 7 dias. Resultados: Não houve diferença entre os grupos dos emétropes, dos hipermétropes e dos míopes com nenhuma droga instilada (p>0,005). O ciclopentolato a 1 % e a associação entre as drogas proporcionaram menor acomodação residual estatisticamente significante, em comparação com a tropicamida a 1% no grupo dos hipermétropes e dos míopes. Conclusão: O ciclopentolato a 1% e a associação entre as drogas são seguras para o exame refratométrico estático em pacientes jovens, com íris escura e sem doença ocular, pois proporcionaram uma média da acomodação residual em todos os grupos pesquisados de no máximo 1,21 ± 0,7 dioptrias esféricas (DE).

Facial Paralysis: Diagnosis and Management

Facial paralysis is a condition frequently seen in otology and audiology clinics. Its most common etiologies are idiopathic, trauma and infection. This article deals with the pathophysiology of facial paralysis, diagnostic technique and treatment modalities illustrated with case studies. The section on pathophysiology includes a discussion of the classification of nerve injury: neuropraxia that may be associated with a compressional injury, axonotmesis associated with an interruption of the myelin layer and axon and neurotmesis involving a complete transection. Among diagnostic techniques, evoked facial electromyography or electroneuronography and needle EMG are discussed and compared. Needle EMG in particular is useful in cases with complete facial paralysis and an evoked EMG reduction of 90% or more. Among patients with idiopathic facial paralysis approximately 71% recover completely and approximately 16% remain with serious sequelae. In terms of treatment, corticosteroids and antiviral medications may be used. Surgical decompression may be used in selected cases to relieve intraneural pressure.

Nerve Regeneration: Basic and Applied Aspects

Increased knowledge is shedding new light on our understanding of central and peripheral nerve anatomy and molecular biology and function. New tools and methods provide important methods for the study of the behavior of cells, axons, and receptors. This review discusses the current state of that knowledge, with particular regard to the efficacy of the Seddon classification of nerve injury. The correlation of that new information to damage and repair of the peripheral sensory nerve, especially the inferior alveolar and lingual nerves, serves to highlight the progress and problems that exist.

Classification of Nerve Injuries

SUMMARY This article has presented a variety of nerve injury classification schemes. It is evident that many factors must be considered in order to develop a treatment plan for nerve injuries. There is no “cookbook” approach for the management of nerve injuries. Each nerve injury is unique and requires a unique treatment plan based on the specific details of the injury. The treatment of nerve injuries is facilitated and the mystery minimized when the various classification schemes presented in this article are used to develop specific problem lists and diagnoses.

Pathophysiology of Injured Axons

In this article we have touched briefly upon certain changes in peripheral axonal physiology which may, in part, explain the mechanisms of painful nerve injury. The next article discusses surgical approaches to these disorders and how they may relate to the known pathophysiology of injured axons.

The anatomy and physiology of nerve injury

Nerves have a structure of considerable complexity with features of special relevance to nerve injury and nerve regeneration. These include variations in the cross-sectional areas devoted to fascicular and epineurial tissue, the fascicular redistribution and mixing of different branch fibers brought about by fascicular plexuses, and the numbers of nerve fibers representing individual branches. The elasticity and tensile strength of nerve trunks and their capacity to resist traction deformation reside in the fascicular tissue, while the epineurium provides a protective cushion against compression. The microstructure of nerve trunks provides the basis for a classification of nerve injuries into five degrees of severity with partial and mixed types--each with a clearly defined pathology and distinguishing clinical features. Following a transection injury, changes occur in the severed axons, endoneurial tubes, fasciculi, and nerve trunk. The type of injury and the nature of these changes determine the outcome of axon regeneration.

The Facial Palsies

The authors of The Facial Palsies present a compendium of current knowledge and practice with a large bibliography and numerous figures. Fifteen of the 19 chapters are by J. Moldaver, who stresses electrodiagnostic tests. The large number of test figures may delight the technician, but have questionable relevance to the clinician. Moldaver advocates revival of intensity-duration curves (chronaxie) and less emphasis on conduction time and electromyography. Peripheral motor-unit tests are stressed over trunk stimulation of the facial nerve. A modified classification of nerve injuries is proposed, but Moldaver questions the ability to accurately localize and forecast prognosis because of pathology mixtures and bundle sparings. Bell's palsy is considered an acute nonprogressive condition, probably of viral etiology, which is not influenced by medical treatment or decompression. His warnings against slitting the epineurium and perineurium are corroborated by P. S. Spencer's histological findings. Scholarly discussions of anatomic and ethnic variations of mimetic

NERVE GRAFTING IN THE REPAIR OF COMPLICATED PERIPHERAL NERVE TRAUMA

Peripheral nerve trauma has been a challenge to surgeons, with significant advances in the surgery of repair occurring in major wars. The standard method of treatment involving wide mobilization and end-to-end suture to close traumatic gaps in peripheral nerves has not produced consistently acceptable results, particularly with large gaps. However, with the recent development of microsurgical techniques and instrumentation, the method of interfascicular nerve grafting has been applied to selected patients with trauma problems of the peripheral nerve, by resecting and autogenous nerve grafting at staggered levels to distribute scar formation, followed by plaster immobilization for 3 weeks. Ten patients are reported, with motor nerve recovery ranging from M2 to M4 and sensory recovery, S2-S4 (See Table I), based on Seddon's classification (11).

Considerations on Surgical Indications for Intratemporal Facial Paralysis

A lesion within the temporal bone is responsible for 90 per cent of all the cases of peripheral facial paralysis, so that it is the otologist's duty to undertake the investigation and treatment of them.From the point of up-to-date electrodiagnosis as well as Seddon's classification of nerve injuries, changing concepts about the indications for surgical decompression of the facial nerve are reviewed.We have arrived at the following conclusions I. Life-saving decompression: —Saving the nerve fibers from degenerating, decompression should be done before it is too late (by the seventh, at the latest the fourteenth day), as soon as loss of nerve excitability occurs.II. Life-giving decompression: —Activating the “potential” vitalities of injured nerve to the “actual” ones, decompression should be done when and after fibrillations are found. The term of validity usually covers from a few weeks to a few months, exceptionally extends over a few years from the onset of the paralysis.Now we would be inclined to say daringly: “Facial paralysis, a medical emergency; if the facial nerve starts losing its excitability, then a surgical emergency!”

A CLASSIFICATION OF NERVE INJURIES

A CLASSIFICATION OF NERVE INJURIES Get access H. J. Seddon H. J. Seddon Search for other works by this author on: Oxford Academic PubMed Google Scholar British Medical Bulletin, Volume 1, Issue 7, September 1943, Page 76, https://doi.org/10.1093/oxfordjournals.bmb.a070207 Published: 01 September 1943