The peripheral nervous system is a network of 43 pairs of motor and sensory nerves that connect the brain and spinal cord (the central nervous system) to the entire human body. These nerves control the functions of sensation, movement and motor coordination. They are fragile and can be damaged easily. When one of these nerves suffers serious injury or trauma, surgical treatment may be called for. Peripheral nerve injuries include: Brachial plexus injury Peroneal nerve injury (foot drop) Spinal accessory nerve injury Peripheral nerve injuries can be mild or serious, and can be graded on the Sunderland scale, which defines five degrees of severity. Injuries may be treated with nonsurgical or surgical therapy. What causes peripheral nerve injury?Injury to the peripheral nerve network can happen through:
Peripheral Nerve Injury SymptomsPeople with traumatic nerve damage can experience severe, unrelenting pain, burning sensation, tingling or total loss of sensation in the part of the body affected by the damaged nerve. Peripheral Nerve Injury ClassificationA classification system called the Sunderland classification system defines five different degrees of peripheral nerve injury:
Spinal Accessory Nerve InjuryOne particular type of peripheral nerve damage is spinal accessory nerve injury. The spinal accessory nerve is the 11th of 12 cranial nerves, which originate in the brain. It allows two sets of muscles in the neck to function: the sternomastoid muscles, which allow the head to tilt and rotate, and the trapezius muscles, which allow for several motions, such as shrugging the shoulder or moving the shoulder blades. The spinal accessory nerve can be damaged during trauma or even during surgery when surgeons are operating on lymph nodes or on the jugular vein in the neck. The symptoms are shoulder pain, outward “winging” of the shoulder blades, and weakness or atrophy of the trapezius muscle. Prompt diagnosis and treatment provides the best chance for recovery from this injury. Doctors are likely to recommend physical therapy for mild spinal accessory nerve injury. Surgery may be needed for more severe injuries, and may involve nerve grafting, nerve regeneration or tendon or muscle transfer. Diagnosis of Peripheral Nerve InjuryIn order to fully determine the extent of the damage to the nerve, the doctor may order an electrical conduction test to determine the passage of electrical currents through
the nerves. Two of these tests are electromyography and nerve conduction velocity. These tests are sometimes done during actual surgery while the patient is sedated.
Peripheral Nerve Injury TreatmentDepending on the location and degree of the nerve damage, the doctor may prescribe different courses of therapy.
More severe injuries may require peripheral nerve surgery, which is performed by a neurosurgeon. These surgical procedures can be highly complicated and this is why it is essential to select an experienced surgeon and team for peripheral nerve operations. Procedures include:
An Innovative Approach to Nerve Repair | Santi’s Story
Santi's sciatic nerve was severed in a boating accident, paralyzing his right leg. He and his family traveled from Texas to Baltimore, where they met with neurosurgeon Allan Belzberg and orthopaedic trauma surgeon Greg Osgood. Together, the two surgeons collaborated to offer a novel way to repair Santi's leg and get him back to the water. Which veins should be avoided to reduce chances of nerve damage?Risk of nerve damage is higher especially when the cephalic vein is punctured in the lower part of the cubital fossa, making it a dangerous area for venipuncture.
Which of these veins is more likely to move and be damaged during venipuncture?Major arm veins used for phlebotomy. The median cubital vein is the larger and more stable vein and is preferred for venipuncture. The cephalic and basilic veins have a greater tendency to roll and veinpuncture may be more painful from these sites.
Which conditions should be avoided for venipuncture?Inappropriate sites for venepuncture are arm on side of mastectomy, edematous areas, haema- tomas, arms in which blood is being transfused, scarred areas, arms with fistulas or vascular grafts and sites above an intravenous cannular [5].
Which of the following veins is most likely to collapse during phlebotomy?The cephalic vein is a safe alternative to the median antecubital vein when necessary. Similar to the top two choices, the basilic vein is on the medial side of the arm. Drawing blood from this area does pose a greater likelihood of the vein rolling or collapsing because it is difficult to anchor.
|