Neurosurgery pp 441-444 | Cite as

Basics: Aetiology, Pathophysiology, General Symptomatology and Diagnosis of Peripheral Nerve Injuries

  • Bent Lange
  • Jens Haase
Part of the European Manual of Medicine book series (EUROMANUAL)

Abstract

An injury to a peripheral nerve may cause life-long functional disabling deficits, and have a considerable impact on the patient’s quality of life. After a nerve injury outside the central nervous system, numerous reactions are initiated in the chain of neurones from the brain to the muscles and the peripheral receptors. In 1941 Cohen introduced a classification system that was later popularised by Seddon [1]. Sunderland extended the system in 1951 with the definition of five degrees to describe the severity of the injury to the nerve [2]. The classification is based on the normal anatomy of the nerve. Finally MacKinnon added one more pattern of pathology in 1988 introducing the partial lesion, often described as a sixth degree of nerve injury [3]. The classification is illustrated in Table 5.1.1.

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Seddon HJ (1943) Three types of nerve injury. Brain 66:237–288CrossRefGoogle Scholar
  2. 2.
    Sunderland S (1951) A classification of peripheral nerve injuries producing loss of function. Brain 74:491–516CrossRefPubMedGoogle Scholar
  3. 3.
    Mackinnon SE (1989) New directions in peripheral nerve surgery. Ann Plast Surg 22:257–273PubMedCrossRefGoogle Scholar
  4. 4.
    Mazal PR, Millesi H (2005) Neurolysis: is it beneficial or harmful. In: Alexandre A, Bricolo A, Millesi H (eds) Advances in peripheral nerve surgery and minimal invasive spinal surgery. Springer, Wien New YorkGoogle Scholar
  5. 5.
    Kömürcü F, Zwolak P, Benditte-Kepetko H, Deutinger M (2005) Management strategies for peripheral iatrogenic nerve lesions. Ann Plast Surg 54:135–142CrossRefPubMedGoogle Scholar
  6. 6.
    Liguori GA (2004) Complications of regional anesthesia. J Neurosurg Anesthesiol 16:84–86CrossRefPubMedGoogle Scholar
  7. 7.
    Rempel MD, Diao E (2004) Entrapment neuropathies: pathophysiology and pathogenesis. J Electromyogr Kinesiol 14:71–75CrossRefPubMedGoogle Scholar
  8. 8.
    Osterman AL (1988) The double crush syndrome. Orthop Clin North Am 19:147–155PubMedGoogle Scholar
  9. 9.
    Maggi SP, Lowe JB, Mackinnon SE (2003) Pathophysiology of nerve injury. Clin Plastic Surg 30:109–126CrossRefGoogle Scholar
  10. 10.
    Burnett MG, Zager LE (2004) Pathophysiology of peripheral nerve injury: a brief review. Neurosurg Focus 16:e1CrossRefPubMedGoogle Scholar
  11. 11.
    Lundborg G (2003) Nerve injury and repair: a challenge to the plastic brain. J Peripher Nerv Syst 8:209–226CrossRefPubMedGoogle Scholar
  12. 12.
    Dahlin LB (2004) The biology of nerve injury and repair. J Am Soc Surg Hand 4:143–155CrossRefGoogle Scholar
  13. 13.
    Lundborg G (2000) A 25-year perspective of peripheral nerve surgery: evolving neuroscientific concepts and clinical significance. J Hand Surg 25A:391–414Google Scholar
  14. 14.
    Lundborg (2005) Chronic nerve compression. In: Lundborg G (ed) Nerve injury and repair, 2nd edn. Churchill Livingstone, New YorkGoogle Scholar
  15. 15.
    Stoll G, Jander S, Myers RR (2002) Degeneration and regeneration of the peripheral nervous system: from Augustus Waller’s observations to neuroinflammation. J Peripher Nerv Syst 7:13–27CrossRefPubMedGoogle Scholar
  16. 16.
    Liss AG, af Ekenstam FW, Wiberg M (1996) Loss of neurons in the dorsal root ganglia after transection of a peripheral sensory nerve. An anatomical study in monkeys. Scand J Plast Reconstr Hand Surg 30:1–6CrossRefGoogle Scholar
  17. 17.
    Gordon T, Sulaiman O, Gordon Boyd J (2003) Experimental strategies to promote functional recovery after peripheral nerve injuries. J Peripher Nerv Syst 8:236–250CrossRefPubMedGoogle Scholar
  18. 18.
    Badalamente MA, Hurst LC, Ellstein J, McDevitt CA (1985) The pathobiology of human neuromas: an electron microscopic and biochemical study. J Hand Surg [Br] 10:49–53Google Scholar
  19. 19.
    Vernadakis AJ, Koch H, Mackinnon SE (2003) Management of neuromas. Clin Plast Surg 30:247–268CrossRefPubMedGoogle Scholar
  20. 20.
    Rempel D, Dahlin L, Lundborg G (1999) Pathophysiology of nerve compression syndromes: response of peripheral nerves to loading. J Bone Joint Surg Am 81:1600–1610PubMedGoogle Scholar
  21. 21.
    Haase J (2007) Carpal tunnel syndrome: a comprehensive review. Adv Tech Stand Neurosurg 32:175–249CrossRefPubMedGoogle Scholar
  22. 22.
    Rydevik B, Lundborg G, Bagge U (1981) Effects of graded compression on intraneural blood flow. An in vivo study on rabbit tibial nerve. J Hand Surg [Am] 6:3–12Google Scholar
  23. 23.
    Novak CB (2003) Evaluation of the nerve-injured patient. Clin Plast Surg 30:127–138CrossRefPubMedGoogle Scholar
  24. 24.
    Beekman R, Visser LH (2003) Sonography in the diagnosis of carpal tunnel syndrome: a critical review of the literature. Muscle Nerve 27:26–33CrossRefPubMedGoogle Scholar
  25. 25.
    Chiou HJ, Chou YH, Chiou SY, Liu JB, Chang CY (2003) Peripheral nerve lesions: role of high-resolution US. Radiographics 23:e15CrossRefPubMedGoogle Scholar
  26. 26.
    Bendszus M, Wessig C, Solymosi L, Reiners K, Koltzenburg M (2004) MRI of peripheral nerve degeneration and regeneration: correlation with electrophysiology and histology. Exp Neurol 188:171–177CrossRefPubMedGoogle Scholar
  27. 27.
    Grant GA, Britz GW, Goodkin R, Jarvik JG, Maravilla K, Kliot M (2002) The utility of magnetic resonance imaging in evaluating peripheral nerve disorders. Muscle Nerve 25:314–331CrossRefPubMedGoogle Scholar
  28. 28.
    Jarvik JG, Kliot M, Maravilla KR (2000) MR nerve imaging of the wrist and hand. Hand Clin 16:13–24PubMedGoogle Scholar
  29. 29.
    Lundborg G, Rosén B (2004) The two-point discrimination test: time for a re-appraisal? J Hand Surg 29:418–422CrossRefGoogle Scholar
  30. 30.
    Tinel J (2005) “Tingling” signs with peripheral nerve injuries. J Hand Surg 30:87–89CrossRefGoogle Scholar
  31. 31.
    James MA (2007) Use of the Medical Research Council Muscle Strength Grading System in the upper extremity. J Hand Surg [Am] 32:154–156CrossRefGoogle Scholar
  32. 32.
    Seddon HJ (1972) Surgical Disorders of the Peripheral Nerves. Williams & Wilkins, BaltimoreGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2010

Authors and Affiliations

  • Bent Lange
    • 1
  • Jens Haase
    • 2
  1. 1.OrtopaedkirurgienDronninglund SygehusDronninglundDenmark
  2. 2.Institute of Health Science and Technology, Faculties of Engineering, Science and MedicineAalborg UniversityAalborg EastDenmark

Personalised recommendations