Critical Care of the Trauma Patient
Kenneth D Boffard in Manual of Definitive Surgical Trauma Care: Incorporating Definitive Anaesthetic Trauma Care, 2019
High-priority occult injuries: Brain, spinal cord and peripheral nerve injury.Thoracic aortic injury.Intra-abdominal or pelvic injury.Vascular injuries to the extremities.Cerebrovascular injuries – occult carotid/vertebral artery injury.Cardiac injuries.Aerodigestive tract injuries – ruptured bowel.Occult pneumothorax.Compartment syndrome – foreleg, thigh, buttock or arm.Eye injuries (remember to remove the patient's contact lenses).Other occult injuries – hands, feet, digits or joint dislocations.Vaginal tampons.
Applied physiology: neuropathic pain
Peter R Wilson, Paul J Watson, Jennifer A Haythornthwaite, Troels S Jensen in Clinical Pain Management, 2008
A variety of pain-related phenomena, both central and peripheral, have been associated with peripheral nerve injury (Table 1.2). These are generally not mutually exclusive and it is entirely possible that any one of these (or more likely a combination) contribute to symptomatology in individual patients suffering from neuropathic pain. It is therefore inappropriate to attempt to generate a unifying hypothesis of pathophysiology for all neuropathic pain states. The next challenge is to diagnose which of these phenomena may be operative in an individual patient and to interpret each symptom within the mechanistic framework arising from work with neuropathic pain models. In this regard, neuropathic pain is ideally suited to the mechanistic-based approach to treatment.33, 34
Peripheral nerve injuries
Sebastian Dawson-Bowling, Pramod Achan, Timothy Briggs, Manoj Ramachandran, Stephen Key, Daud Chou in Orthopaedic Trauma, 2014
Sunderland enumerated five grades, by expanding neurotmesis into three further subdivisions. However, both classifications relate to an anatomical description of damage to individual neurons. In reality, nerve lesions are often a combination of types, with neurapraxic elements combined with a degree of axonotmesis. The Sunderland classification should therefore be viewed primarily as a research tool. Birch has popularized Bonney’s clinical classification (Table 26.1). The key question to ask about a peripheral nerve injury is: Is this a degenerative or a non-degenerative injury?
Differential diagnosis of knee pain following a surgically induced lumbosacral plexus stretch injury. A case report
Published in Physiotherapy Theory and Practice, 2019
William R. VanWye, Harvey W. Wallmann, Elizabeth S. Norris, Karen E. Furgal
Numerous diseases, injuries, and impairments can alter LE biomechanics. For example, LE tendinopathies, bursitis, ligamentous instabilities, internal derangements, muscle imbalances, or intraarticular pathologies are just a few of the pathologies and disorders that could result in biomechanical disorders PTs face on a daily basis. Another such pathology that may result in altered LE biomechanics is weakness due to a peripheral nerve injury. Mechanisms of peripheral nerve injury include ischemia, vibration, electric shock, radiation, thermal, or more commonly, a laceration, compression, or stretch injury (Campbell, 2008). Trauma-related upper and LE peripheral nerve injuries have an incidence of 2.8% with 17% of the cases being iatrogenic in nature (Noble, Munro, Prasad, and Midha, 1998). Iatrogenic causes are typically associated with surgical factors, such as direct trauma, tourniquet pressure, casting, or radiation (Antoniadis et al, 2014). In addition, surgical positioning can compress or stretch nerves, resulting in ischemia (Barnett et al, 2007).
Neuromuscular disorders in women and men with spinal cord injury are associated with changes in muscle and tendon architecture
Published in The Journal of Spinal Cord Medicine, 2023
Larissa Santana, Emerson Fachin-Martins, David Lobato Borges, Jonathan Galvão Tenório Cavalcante, Nicolas Babault, Frederico Ribeiro Neto, João Luiz Quagliotti Durigan, Rita de Cássia Marqueti
Invasive electromyography has identified neuromuscular electrophysiological disorders (NED) in individuals with complete and incomplete SCI.16–19 The most significant effect on nerve waveform amplitude suggests a predominant axonal involvement. However, there are no definitive findings on neuromuscular function changes observed in individuals with chronic SCI.17,18 Among the modalities used to evaluate peripheral nerve lesions, the Stimulus Electrodiagnosis Test (SET) is a non-invasive examination that quantifies nerve and muscle evoked responses using specific parameters of neuromuscular electrical stimulation (NMES) to measure the rheobase, chronaxie, accommodation, and accommodation index.20–22 Invasive electromyography has been indicated as a relevant test to determine peripheral nerve injury level and severity.23 However, the feasibility of this test may be limited due to its considerable cost, need for a skilled physician, and the inherent risk of an invasive test.24 NED can also be diagnosed by SET, which presents sensitivity ranging from 88% to 100% compared to needle electromyography.21 The chronaxie needs to be considered in the proposal of NMES protocols for experimental and rehabilitation purposes.21,24,25 In addition, a possible mechanism for non-responsivity to NMES parameters has not yet been elucidated after SCI.
Expanded 3D nanofibre sponge scaffolds by gas-foaming technique enhance peripheral nerve regeneration
Published in Artificial Cells, Nanomedicine, and Biotechnology, 2019
Feng Rao, Zhipeng Yuan, Ming Li, Fei Yu, Xingxing Fang, Baoguo Jiang, Yongqiang Wen, Peixun Zhang
Trauma-induced peripheral nerve injury is a common clinical problem that often leads to permanent loss of motor and sensory function, causing immense trouble for families and society [1–4]. Peripheral nerve injury has a certain capability to regenerate, but many limitations in the process of nerve regeneration often lead to poor recovery [5]. Therefore, surgical treatment is generally required after peripheral nerve injury. For the small nerve defect, epicardial or perimamial anastomosis is used. However, these surgical procedures often lead to formation of scars and neuroma [5]. Jiang et al. [6,7] uses chemotaxis theory to develop chitosan conduit to suture a neural stump with a small gap (2 mm); this suture technique reduces the operation time while avoiding the formation of scars and neuroma, and the restoration effect is better than that of epineurial neurorrhaphy.
Related Knowledge Centers
- Central Nervous System
- Glia
- Nervous Tissue
- Reinnervation
- Wallerian Degeneration
- Connective Tissue
- Injury
- Peripheral Nerve Injury Classification
- Nerve
- Neuroregeneration