Injury to peripheral nerves is commonly caused in the course of performing invasive or non-invasive procedures, or by repetitive work. Prevention is mostly based on the avoidance of these hazards.
There are no common treatments for peripheral nerve injuries. Peripheral nerve injuries require a wide variety of treatments that are individualized based on the nature and location of the injury and on the patient's comorbidities and needs. The goal of treatment depends on the severity and degree of nerve compression and/or injury and is chosen by the treating physician. While there are few high-quality trials, the use of surgical techniques, nerve-sparing surgical techniques, and endoscopic nerve-sparing techniques can preserve function and reduce recovery time and risk of nerve morbidity. TENS is effective as an adjunctive therapy to other treatments before a muscle-relaxation technique in cases of persistent pain.
The authors present a list of pertinent signs of nerve injuries and their importance to recognize and record in patients. They also suggest the use of a clinical prediction model that may help guide preoperative management in patients presenting with peripheral nerve injuries.
Peripheral nerve injuries are a group of diseases that can cause numbness, tingling, paralysis or even amputation. PNI are usually due to traumatic injury in which sharp objects or bones and joints may be fractured resulting in nerve damage as well as chronic or repetitive stress. The most common type of peripheral nerve damage is entrapment where a nerve becomes trapped for a prolonged period of time between a non-returning tissue that is strong enough to prevent the nerve from escaping such as bone or muscle, which can be further exacerbated by improper surgical technique, such as neurotmesis. Peripheral nerve injuries may also be caused by physical force such as a fracture.
The data collected in this article do not provide a estimate of annual numbers of peripheral nerve injuries. There is a need to standardize the data collection methodology and tools. An objective, standardized system to survey peripheral nerve injuries is crucial to provide a complete estimate of the numbers of individuals affected by nerve injuries in the United States. With the availability of information of patient satisfaction, treatment failures and nerve injuries, information regarding the quality of care provided to patients with peripheral nerve injuries and information about patient satisfaction will be useful tools to measure effectiveness.
A high dose of intravenous glutamine, 2.5% on a day-to-day basis, does accelerate the healing process of nerve injuries and improves recovery of muscular and nerve functions.
Patients who are well and whose injuries are isolated to their superficial nerves are excellent candidates for clinical trial. Patients who sustained more severe injuries or were part of a larger mass lesion and who have additional neurologic abnormalities are candidates for clinical trial. Patients with other injuries that do not alter outcomes and who can achieve better functional outcomes may be candidates for clinical trial.
Ntx-001 is a well-tolerated, simple to use, and very inexpensive analgesic. It does not appear to be associated with an increased risk of adverse effects, particularly fractures. It is an effective analgesic when used in people with a history of or ongoing lower spine osteoporotic fractures including in the setting of other chronic pain syndromes.
Ntx-001 is being investigated as a medication for the treatment of several central nervous system diseases. Ntx-001 is currently in clinical trial in patients with Parkinson's disease and multiple sclerosis. The drug is also in clinical trial in patients with chronic pain. Ntx-001 was granted a conditional marketing authorisation pending the results of two ongoing Phase III trials. There were no other published clinical trials in which Ntx-001 has been investigated. Based on present knowledge and research, the authors did not anticipate that Ntx-001 might be a candidate for use in any of the clinical indications mentioned above.
Ntx-001 has shown promise in preliminary experiments of the treatment of peripheral neuropathies. Clinical trials are planned with further details to be discussed during the next International Meeting on Nerve Damage Treatment (IFENNT 2014 = ISNTNCT00958409) in Vancouver, Canada.
In this small retrospective study, the clinical presentation of Ntx-001 was consistent with that of other NTF2-related neuropathies. In the current situation, Ntx-001 may be considered as an alternative to costly and lengthy immunosuppression.
The primary cause of peripheral nerve injuries was found to be traction during the operative procedure rather than laceration at the site of injury. Wound complications, which included infection, were more critical than the type of nerve injury in determining the long-term function loss.