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Post-traumatic neuropathies

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Post-traumatic neuropathies

Post-traumatic neuropathies is a nerve root disorder that occurs after mechanical trauma to the nerve:

  • operations
  • injuries, including after injection of the drug (post-injection neuritis)
  • impacts and prolonged clamping
  • bone fractures and joint dislocations

Post-traumatic neuropathies, depending on the level and type of nerve damage, will manifest itself in a variety of symptoms: movement disorders (paresis, paralysis) in a particular muscle or muscle group, numbness, changes in sensitivity (strengthening, weakening, or perversion).

Damage to the radial nerve at the site of the fracture of the humerus.

Traumatic neuropathy of the ulnar nerve with a fracture of the ulna.

Traumatic neuritis is common in fractures or dislocation of bones and joints of the extremities due to their anatomical proximity. After diagnosing the level of nerve damage, treatment is started taking into account the symptoms of nerve root damage.

Traumatic fibular (peroneal) nerve neuropathy with fibular fracture.

Traumatic neuropathy of the tibial nerve with a fracture of the tibia.

Post-traumatic neuropathies causing persistent pain symptoms (neuralgia) or hypesthesia (decreased sensation) or muscle paresis (decreased strength) takes time and patience and responds well to treatment.

Injuries to such a large nerve as the sciatic nerve are rarely complete. More often, this or that portion of the sciatic nerve suffers more.

Post-traumatic sciatic nerve neuropathy, when compressed by a scar, causes a "lumbago" pain throughout the leg.

 

Diagnosis of traumatic neuropathy

Neuropraxia is a disease of the peripheral nervous system, during which there is a temporary loss of motor and sensory function due to blockage of nerve conduction. Disruption of nerve impulse transmission in neuropraxia usually lasts an average of 6-8 weeks until it is fully restored.

Symptoms of damage to any peripheral nerve in traumatic neuritis consist of motor, reflex, sensory and vasomotor-secretory-trophic disorders. Examination of a patient with traumatic neuritis traditionally begins with the collection of anamnestic information.

Traumatization of the trigeminal nerve with improper performance of conduction anesthesia leads to traumatic neuropathy of the trigeminal nerve.

Classical electrodiagnostic is of great importance in the system of a comprehensive study of a patient with traumatic neuritis in the period from 2 weeks and later after injury, helping to separate degenerative from non-degenerative disorders. Thus, to a certain extent, the prognosis is also determined, since closed damage to the nerve trunks, in particular the brachial plexus, accompanied by degeneration, is always doubtful concerning the completeness and quality of restoration of lost movements, especially in the distal parts of the limb.

At the point of its exit from the cranial cavity, the facial nerve is most often subject to traumatic compression with the clinic of facial nerve neuritis.

Restoration of movements to a force of 4–5 points after traumatic neuritis is observed only in those muscles in which, with classical electrodiagnostic, reduced electroexcitability or a reaction of partial nerve degeneration is revealed.

With the reaction of complete degeneration of the nerve after traumatic neuritis, the restoration of movement in the muscles is not observed.

Neuropraxia of the infraorbital nerve (V2 - a branch of the trigeminal nerve) as a result of its damage with blunt trauma.

In very late periods after nerve damage in traumatic neuritis, the identification of the loss of electrical excitability of the paralyzed muscles gives an additional reason in favor of refusing to operate on the nerves. Earlier than in other areas, the electrical excitability of the muscles of the dorsum of the forearm disappears. Contrary to conventional wisdom, the small muscles of the hand often turn out to be more stable in terms of their ability to respond to stimulation by the electric shock.

Electromyography is a very promising research method for closed injuries of the brachial plexus, which makes it possible to record the dynamics of changes in the neuromuscular apparatus during the recovery process. The corresponding electromyographic curve with the appearance of previously absent action potentials in traumatic neuritis makes it possible to expect the restoration of movement long before the first clinical signs of this restoration.

Diagnosis of the level of nerve damage in traumatic neuritis is performed using electroneurography (ENG).

 

Treatment of traumatic neuropathy

Treatment for traumatic neuropathy is selected individually in each case. It includes a set of conservative procedures:

  • acupuncture
  • nerve and muscle stimulation
  • vitamins of group "B", "C" and "E"
  • homeopathic remedies
  • surgical treatment (neurolysis of the nerve trunk, etc.)
The use of acupuncture is very effective in the treatment of traumatic neuropathy of the peripheral nerves.

Neurostimulation (physiotherapy) eliminates paresthesia and pain, restores muscle strength in traumatic neuropathy.

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