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The peripheral nerves include are all of the nervous system connections outside of the brain and spinal cord. They control sensation, movement and autonomic functioning of all organs, muscles and sensations. The motor nerves allow you to walk or shake hands. The sensory nerves let you feel your pet’s fur or a cold glass. Damage to any part of the peripheral nerves can result in the loss of use or feeling in the arm or leg controlled by that nerve. A traumatic nerve injury may be from stretching, trauma or scar healing. A physical exam will indicate the injured nerves and imaging tests can further show the damaged areas. A stretched peripheral nerve injury may heal on its own or require conservative treatment like ice or heat and physical therapy. More severe nerve injuries may require surgical procedures to repair the nerves and restore function. Getting an accurate evaluation and appropriate care will help you get better as quickly as possible.
Symptoms will depend on where the nerve is injured. Traumatic injury to the upper neck nerves can decrease shoulder function while lower neck nerve injury will affect the arm and hand. Traumatic injury to the lower leg nerves can decrease leg and foot movement and feeling. Pain or numbness is usually the first sign of a nerve injury. You may have aching, tingling or burning sensations. The pain is usually only on the injured side of the body. You may be unable to control the arms, hands and legs controlled by the injured nerve. When you are unable to perform your normal daily activities then it is time to see your doctor. A simple nerve stretch may be painful for a couple of weeks and then resolve while a detached nerve will have more severe pain and require surgery to repair.
Anything that stretches, bruises or cuts a peripheral nerve can cause temporary or permanent damage to that nerve. Traumatic nerve injuries occur from contact sports, falls or motor vehicle accidents. Stabbing and gunshots can sever the nerves. Electrical shock can burn the nerves. During a surgical procedure for another condition, positioning the arm may damage nerves or with extemity procedures the nerves may be cut. In most cases the cause will be known as the event that caused the injury occurs at the same time that symptoms begin.
The cause of brachial plexus can be divided into multiple categories. Neuropraxia is stretching or compressing of nerves from trauma that can be called a “burner” or “stinger” due to the sensation caused. A neuroma occurs when the end of a cut nerve grows a painful knot on the end requiring scar removal and capping or reattachment to another nerve. Peripheral nerve ruptures occur when the nerve is overstretched causing a very painful partial or complete tear which can frequently be repaired with surgery. Finally, a nerve avulsion occurs when the nerve root is completely torn from the spine which will most likely not be reparable and causes permanent paralysis and loss of feeling.
Your doctor will take a complete history which may when or how your injury occurred. A physical exam will evaluate you for your source of your pain and discomfort. Your muscle strength and skin sensation will be checked along with reflexes.
Imaging tests can help your doctor identify injured areas of spinal bones and muscles. X-rays of the neck and shoulder may be used to look for fractures or other injuries around the injured nerve. A computed tomography (CT) scan uses the electromagnetic energy of X-rays to provide a detailed look at the bony anatomy and tissue around it. A magnetic resonance imaging (MRI) uses powerful magnets and radio waves to create a detailed picture of soft tissue of the muscles, soft tissue and nerves. Contrast dye may be used during both the CT scan and MRI to better evaluate the area of injury. Nerve conduction studies look for nerve damage by using electrodes to measure how quickly a nerve impulse is transmitted. An electromyogram uses needle electrodes to look for muscle damage. Evaluation of your strength and sensation will be monitored on a regular basis to look for improvement and imaging tests may be repeated as well.
A mild traumatic injury will frequently improve with conservative treatment within a few weeks or months. Resting or exercises given to you by a physical therapist can allow your injury to heal. Ice or heat in the area of discomfort may help you feel better. Over-the-counter medications like ibuprofen (Advil, Motrin) or naproxen (Aleve) are NSAIDs (nonsteroidal anti-inflammatory drugs) that can decrease pain and swelling. Muscle relaxants and nerve pain medications can also be used. Steroid injections can decrease pain and inflammation. An occupational therapist can help you with skills to improve daily functioning when there is prolonged pain or weakness.
Surgery may be needed if your traumatic nerve injury is severe or if conservative treatments do not provide pain relief an improve function. Nerve repair can take anywhere from months to years for the nerve to function. You would also want to undergo surgery no later than 6 months after your injury for best results. Our neurologists can let you know if you are a good candidate for nerve surgery. You may require one or a combination of the following procedures:
Muscle transfers can move a less important muscle to a more important muscle to increase function.
The pain and loss of function from a traumatic nerve injury can be excruciating and debilitating. The Norelle Health neurosurgeons are highly trained and skilled in the diagnosis, management, and treatment of all traumatic nerve injuries. Our neurosurgeons can provide the optimal treatment. Neurosurgery is considered essential by insurances and should be covered with your plan. As out-of-network providers, we will check your benefits for you and let you know what they are so there are no surprises. We use an individualized treatment plan for your concerns to provide a personalized holistic plan of care. If you would like assistance, please feel free to contact us (link to contact page) or call our office (link to phone number).