Peripheral nerve injury is a common and frequent clinical condition that can be caused by a variety of factors, such as trauma, infection, compression, ischemia, and tumor. After peripheral nerve injury, early edema and sterile inflammatory reaction affect the repair and regeneration of the nerve, while the nerve injury itself and around the injury can produce scar tissue, leading to nerve adhesions and scar compression, forming entrapment, which can also affect nerve regeneration.
Classification of peripheral nerve injury
1.Nerve loss
Also known as nerve shock, is a mild nerve injury, manifested as temporary conduction block of nerve fibers, but the continuity of nerve fibers or nerve sheaths does not change, mostly caused by blunt injuries.
2.Axon rupture
The axon is broken but the nerve sheath is intact, and the distal nerve fibers have Wallerian degeneration, which can be manifested as motor and sensory dysfunction in the corresponding nerve distribution area, with jong-ru atrophy and neurotrophic changes, which can recover by itself after a period of time.
3.Nerve rupture
The nerve bundle or nerve trunk is completely broken, that is, the axon, myelin sheath and nerve membrane are completely transected, and the nerve function is completely lost. If the two severed ends of the nerve are close together, the nerve section increases and there is no obstruction between the sections.
Clinical manifestations
1, motor dysfunction: manifested as hypotonia, sluggish muscle paralysis, muscle atrophy, and abnormal limb posture.
2, sensory dysfunction: subjective sensory disorders, such as abnormal sensation, spontaneous pain, phantom pain, etc. in the absence of external stimuli; objective sensory disorders: such as sensory loss, hyperalgesia, sensory hypersensitivity, etc.
3, abnormal reflexes: such as deep and superficial reflexes are weakened or disappeared.
4.Autonomic nerve dysfunction: it can be manifested as irritative injury and destructive injury; irritative injury such as skin redness, moist, hyperkeratosis, etc.; destructive injury such as skin cyanosis, coldness, dryness, etc.
Treatment
Patients with peripheral nerve injury should eliminate the cause as early as possible to reduce its damage to the nerve, and early and proper treatment can achieve better results. Comprehensive treatment is taken early to improve the functional impairment caused by nerve injury. For nerve injuries generally take non-surgical treatment first, and those who still have not recovered after 1-3 months should be surgically explored.
1, drug treatment: for peripheral nerve injury, also with hormone therapy, such as prednisone or dexamethasone, patients with obvious pain symptoms, analgesic drugs can be used to help their pain relief.
2, surgical treatment: open nerve injury is mostly nerve fracture, should be early surgical treatment; combined with closed fracture and dislocation of nerve injury, mostly due to pulling or contusion, early fracture and dislocation should be rectified.
Rehabilitation program
Patients with peripheral nerve injuries usually have motor dysfunction, sensory perceptual dysfunction, reflex and autonomic dysfunction, psychological dysfunction and other problems resulting from this, such as inability to care for themselves in daily life. Regardless of whether non-surgical or surgical treatment is used, proper rehabilitation is an effective way to accelerate nerve regeneration and restore function. The goal of clinical rehabilitation is to prevent complications and comorbidities, to promote nerve regeneration, to maintain muscle mass for nerve reinnervation, to promote the recovery of motor and sensory functions, and ultimately to improve the patient’s ability to live and work, and to improve the patient’s quality of life.
1.Exercise therapy
Exercise therapy has the effect of accelerating blood circulation, enhancing muscle strength and preventing muscle and joint contracture, and emphasizes the active participation of patients. In the early stage of nerve injury, the main purpose is to maintain the functional position and prevent the occurrence of joint contracture and deformation. Exercise should be performed within the pain-free range, or within the normal range of motion of the joint, without over-stretching the paralyzed muscles. After peripheral nerve and tendon sutures have been placed and adequately immobilized, exercise should not begin until afterwards. When active movement is possible, active movement is to be actively performed.
Depending on the muscle strength recovery, different exercise training is performed. When the muscle strength is at level 1, isometric contraction and assisted contraction can be done, and when the assistance is at level 2 or higher, assisted contraction and active exercise under removal of gravity can be performed. When the muscle strength is at level 3 and above, resistance training, speed, endurance, coordination and balance training can be performed to continuously strengthen the muscle strength for maximum recovery.
2.Physical therapy
Ultrasonic therapy can promote local blood circulation, improve metabolism, soften connective tissue, reduce the adhesion and compression of scar tissue to nerves, and promote the regeneration of nerves. Low-medium frequency electrotherapy and laser therapy are anti-inflammatory and promote nerve regeneration. Early application of ultrashort wave and microwave without heat or microheat has the effect of eliminating inflammation, promoting edema absorption, and facilitating nerve regeneration. And warm water bath and other hydrotherapy methods can relieve muscle tension and promote local circulation, and at the same time, due to the buoyancy effect of water, it is also conducive to exercise training.
3.Operational therapy
According to the site and degree of dysfunction, muscle strength and endurance test results, the patient should carry out relevant occupational therapy, such as daily life activity training, knitting, typing, sculpting, literary and recreational activities, etc., according to the problems that exist. During the treatment process, the difficulty and duration of the training should be gradually increased to strengthen the muscle flexibility and endurance, and at the same time, care should be taken to prevent mechanical frictional injuries due to the presence of sensory impairment in the patient. Some purposeful therapeutic activities can also be designed according to the patient’s condition.
4.Psychotherapy
Patients with peripheral nerve injury are often accompanied by psychological problems, impatience, anxiety and depression due to the long duration of the disease and slow healing, therefore, there should be a comprehensive treatment for each patient, using psychological counseling and other means to eliminate or reduce the patient’s psychological barriers.
5.Tui na, massage
Massage can improve blood circulation, loosen tissue adhesions and prevent muscle atrophy. According to different parts of the patient, different techniques are used for massage and tui-na treatment.
6.Orthotics
The use of orthoses is mainly to prevent the occurrence of contractures and other deformities. During the recovery period, splinting has the function of correcting deformity and assisting movement, and for patients who have contracture, there is also the function of correcting contracture. Power splints can provide or assist in the movement of paralyzed muscles.
Summary.
With the development of rehabilitation medicine, rehabilitation therapy is increasingly showing its superiority. After peripheral nerve injury, different methods of comprehensive rehabilitation therapy should be selected according to the patient’s nerve injury and different periods of injury to achieve the best results. Rehabilitation treatment is based on exercise therapy, and the active participation of the patient should be emphasized.