Scientific/Clinical ArticleEvaluation of Nerve Injury and Nerve Compression in the Upper Quadrant
Section snippets
Chronic Nerve Compression
Patients with chronic nerve compression have wide variability in the presenting subjective symptoms and physical signs. In the motor system, these changes may progress from muscle ache and weakness to muscle atrophy. Sensory complaints will vary from intermittent paraesthesia to constant numbness. This spectrum of patient presentation likely relates to the range of neural histopathologic changes that occur with chronic nerve compression (Figure 1). Documentation of chronic histopathologic
Multiple and Double Crush Syndromes
Upton and McComas7 presented the concept of the double crush mechanism where a proximal level of nerve compression will cause the distal entrapment sites to be less tolerant to compressive forces. The authors presented a clinical patient review with a high prevalence of distal nerve compression with cervical root lesions.7 Therefore, they concluded that the summation of neural compression may alter axoplasmic flow thus contributing to patient symptoms. Lundborg6 introduced the concept of the
Nerve Injury
Disruption of nerve continuity and neural transmission will result in a number of alterations, not only at the site of the injury, but also at the proximal and distal nerve segment, the distal sensory/motor end organ, the cell body, and the central cortex.
In 1943, Seddon9 introduced a classification system for nerve injury that included three levels: neurapraxia, axonotmesis, and neurotmesis. Sunderland10 expanded the classification of nerve injury to five degrees of nerve injury (I–V). A first
Motor Evaluation
Muscle strength can be assessed qualitatively or quantitatively. Initial changes with chronic nerve compression will include muscle aching followed by weakness and finally muscle atrophy. However, alteration in muscle function may not be detected in patients with mild nerve compression. Muscle atrophy, if present, can be graded by visual assessment as mild, moderate, or severe. This will only occur in cases of traumatic injury to a motor nerve or with severe nerve compression.
There are several
Conclusion
The evaluation of patients with nerve injury and/or nerve compression requires an accurate history and subjective report to determine the tests that will be most useful in providing the essential information. Motor and sensory evaluation are necessary in global mixed nerve injuries, but in cases of nerve compression, tests of provocation will give more accurate information in detecting the site of nerve compression. Multiple levels of nerve compression can increase sensory sensitivity and can
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Nerve Injury and Repair
Three types of nerve injury
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Nerve and Nerve Injuries
Surgery of the Peripheral Nerve
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Muscle Nerve
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This article has been modified from Novak CB. Evaluation of the nerve injured patient. Clin Plast Surg. 2003;30:127–38, with permission.