Injury of a nerve – full or partial violation of integrity of a nerve owing to wound, blow or a sdavleniye. Can arise at any kinds of injuries. Is followed by sensitivity violation, loss of motive functions and development of trophic frustration in an innervation zone. Is heavy damage, it becomes frequent the reason of partial or full disability. The diagnosis is established on the basis of clinical signs and data of a stimulation electromyography. Treatment is complex, combines conservative and operational actions.
Injury of a nerve
Injury of a nerve – the widespread severe injury caused by a full or partial break of a nervous trunk. The closed injuries of a nerve arise owing to a sdavleniye of soft fabrics a foreign subject (for example, at stay under a blockage), blow by a blunt object, the isolated nerve sdavleniye a tumor, otlomky bones at a change or the dislocated end of a bone at dislocation. Open injuries of a nerve in peace time turn out to be consequence of cut wounds, during military operations more often – gunshot wounds. The closed damages, as a rule, happen incomplete therefore proceed more favorably.
Nervous tissue badly regenerates. Besides, at similar injuries in a disteel part of a nerve Vallerova a degeneration – process at which nervous tissue resolves and replaced with cicatricial connecting fabric develops. Therefore it is difficult to guarantee the favorable result of treatment even at high qualification of the surgeon and adequate restoration of integrity of a nervous trunk. Injuries of nerves often become the reason of restriction of working capacity and an exit to disability. Treatment of such injuries and their consequences is performed by neurosurgeons and traumatologists.
Injuries of a nerve are followed by sensitivity loss, violation of motive function and trophic frustration. In an autonomous zone of an innervation sensitivity completely is absent, in the mixed zones (the fields of transition of an innervation from one nerve to another) the sites of decrease in sensitivity alternating sites of a giperpatiya (a sensitivity perversion at which in response to action of harmless irritants there is pain, an itch or other unpleasant feelings) come to light. Violation of motive functions is shown by sluggish paralysis of the innervated muscles.
Besides, in the field of defeat develops skin and vasomotorial violations. Within the first three weeks the hot phase (skin red, its temperature is raised), which is replaced by a cold phase is observed (skin becomes cold and gets a cyanotic shade). Over time in the struck area there are trophic frustration which are characterized by thinning of skin, decrease in its turgor and elasticity. In the remote terms rigidity of joints and osteoporosis comes to light.
Depending on weight of injury of a nerve allocate the following frustration:
- Concussion. Morphological and anatomic violations are absent. Sensitivity and motive functions recover in 10-15 days from an injury.
- Bruise (contusion). The anatomic continuity of a nervous trunk is kept, separate damages of an epinevralny cover and hemorrhage in nerve tissue are possible. Functions are restored approximately in a month after damage.
- Sdavleniye. Expressiveness of frustration directly depends on weight and duration of a sdavleniye, both insignificant passing violations, and the permanent loss of functions demanding performing surgery can be observed.
- Partial damage. Loss of separate functions is noted, it is frequent – in combination with the irritation phenomena. Spontaneous restoration, as a rule, does not happen, operation is necessary.
- Full break. The nerve is divided into two ends – peripheral and central. In the absence of treatment (and in some cases and at adequate treatment) the median fragment is replaced with the site of cicatricial fabric. Spontaneous restoration is impossible, in the subsequent the accruing atrophy of muscles, violations of sensitivity and trophic frustration is observed. Surgical treatment is required, however, the result not always happens satisfactory.
Injury of an elbow nerve, first of all is shown by motive frustration. Active bending, cultivation and data of V and IV and partially the III fingers is impossible, force of muscles is sharply weakened. Within 1-2 months the atrophy of interosseous muscles develops owing to what on the back of a brush contours of pyastny bones begin to be allocated sharply. In the remote period there is a characteristic deformation of a brush in the form of a claw. Average and disteel phalanxes V and IV fingers are in a condition of bending. Opposition of a little finger is impossible. On the elbow party of a brush disorders of sensitivity, sekretorny and vasomotorial violations are observed.
Injury of a median nerve is followed by the expressed sensitivity violation. Besides, already in an initial stage trophic, sekretorny and vasomotorial violations are well noticeable. The skin of the innervated area which is shelled, brilliant, tsianotichny, dry, smooth and vulnerable. Nails of the I-III fingers cross of an ischerchena, hypodermic cellulose of nail phalanxes is atrophied. The nature of motive frustration is defined by the level of injury of a nerve.
Low defeats are followed by paralysis of muscles of the tenor, high – violation of palmar bending of a brush, the pro-nation of a forearm, extension of average phalanxes III and II fingers, bendings of the I-III fingers. Opposition and assignment of the I finger is impossible. Muscles gradually atrophy, their fibrous degeneration therefore at prescription of a trauma over a year restoration of their function becomes impossible develops. "the monkey brush" is formed.
Injury of a beam nerve at the level of a shoulder or axillary area is followed by bright motive violations. There is a paralysis of a razgibately brush and a forearm which is shown a symptom of the hanging-down or "falling" brush. At damage of underlying departments only disorders of sensitivity develop (usually as a gipesteziya). The back surface of the beam party of a brush and phalanxes of the I-III fingers suffers.
Injury of a sciatic nerve is shown by violation of bending of a shin, paralysis of fingers and feet, loss of sensitivity on the back surface of a hip and practically on all shin (except for an internal surface), and also loss of an akhillov of a reflex. The kauzalgiya – the painful burning pains in a zone of an innervation of the injured nerve extending to all extremity, and sometimes and to a trunk is possible. Partial injury of a nerve with loss of functions of its separate branches is often observed.
Injury of a tibial nerve is shown by loss of an akhillov of a reflex, violation of sensitivity of the outer edge of foot, sole and back surface of a shin. Typical deformation is formed: foot is unbent, the back group of muscles of a shin is atrophied, fingers are bent, the arch of foot is deepened, the heel acts. Walking on tiptoe, the turn of foot of a knutra, and also bending of fingers and foot are impossible. As well as in the previous case, the kauzalgiya quite often develops.
Injury of a low-tibial nerve is followed by paralysis of razgibatel of fingers and feet, and also muscles which provide turn of foot of a knaruzha. Violations of sensitivity on the back of foot and external surface of a shin are noted. Characteristic gait is formed: the patient highly raises a shin, strongly bending a knee, then lowers a leg on a sock and only then on a sole. Kauzalgiya and trophic frustration are, as a rule, not expressed, akhill the reflex is kept.
In diagnosis an important role is played by survey, a palpation and a neurologic research. At survey pay attention to typical deformations of an extremity, skin color, trophic violations, vasomotorial frustration and a condition of various groups of muscles. All data compare to a healthy extremity. At a palpation estimate humidity, elasticity, turgor and temperature of various sites of an extremity. Then conduct a sensitivity research, comparing feelings in a healthy and sore extremity. Define tactile, painful and temperature sensitivity, feeling of localization of irritation, articulate muscle sense, (recognition of a subject to the touch, without sight control), and also feeling of two-dimensional irritations (definition of figures, figures or letters which the doctor "draws" on the patient's skin).
The leading additional method of a research is the stimulation electromyography now. This technique allows to estimate depth and a damage rate of a nerve, to find out the speed of carrying out impulses, a functional condition of a reflex arch etc. Along with diagnostic value, this method has also a certain predictive value as allows to reveal early signs of restoration of a nerve.
treatment should be carried out only under the supervision of a doctor. Self-treatment is unacceptable!!!
Treatment of injuries of a nerve complex, are used both surgical techniques, and conservative therapy. Conservative actions begin from the first days after a trauma or surgery and continue up to an absolute recovery. Their purpose – the prevention of development of contractures and deformations, stimulation of reparative processes, improvement traffic, maintenance of a tone of muscles, prevention of fibrosis and scarring. Apply LFK, massage and physiotreatment, including – UVCh, an electrophoresis with novocaine, calcium and gialuronidazy, paraffin, ozokerite and electrostimulation. Appoint the medicamentous stimulating therapy: B12 and B1 vitamins, with nicotinic acid, ATP.
Indications to operation are vegetative and trophic disorders, violations of sensitivity and motive frustration in a zone of an innervation of the injured nerve. Depending on the nature of a trauma and cicatricial changes it can be carried out (excision of hems of a cover of a nerve), an epinevralny seam (comparison of a nerve and sewing together of its cover) or plasticity of a nerve. At the same time the microsurgical technicians allowing to compare precisely identical bunches of the damaged ends of a nervous trunk are widely applied.
The best results are achieved at early surgical interventions – on average no more than 3 months from the moment of a trauma, at injuries of nerves of a brush – no more than 3-6 months from the moment of a trauma. If operation for some reason was not performed in early terms, it should be executed in the remote period as recovery surgical actions practically always allow to improve function of an extremity in a varying degree. However at late interventions you should not count on significant improvement of motive functions as muscles are exposed to fibrous regeneration eventually.