Nerve Injuries - Medical Negligence Solicitors Compensation Claims


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Nerve Injuries

Nerves are generally myelinated fibers that transmit messages of things like pain, touch, hot and cold from the periphery of the body to the brain. Similar fibres transmit information from the brain back to the periphery. Normally these things go at lightning speed so we do things that protect us, such as recognize and pull back from a hot stove. There are several things that can damage the nerves, including surgical errors, Erb’s palsy and other injuries to nerves by providers.

There is no complete classification that can describe the ways in which nerves can be damaged. Doctors have tried to base nerve injuries on several parameters.

There can be neuropraxia, in which there is nerve injury that completely recovers itself. The long axon of the nerve is intact but the myelin coating is interrupted so that, for at least awhile, the nerve conduction is really slow. The most common cause of this type of injury is ischemia or nerve compression. It takes about 6-9 weeks for nerve function to turn to normal. The regeneration is simply to return the myelin to normal levels. Doctors can do nerve conduction studies of the nerves at day ten following the injury and, if this is normal, it is likely neuropraxia and not a more severe damage to nerve.

In axonotmesis, the neuronal axon fibre is disrupted; however, the epineurium is saved. It is usually seen in crush injuries and can cause paralysis of the motor nerve, damage to sensory nerves and problems with the autonomic nervous system. If the force is quick and doesn’t linger on the nerve, it is possible for the nerve to regenerate so there is recovery of function. There is loss of the motor neurons first and nerve testing will show that there will be recovery as long as the endoneural tubules are intact.

In axonotmesis there is loss of the continuity of the axon plus its overlying myelin but there is preservation of the connective tissue framework of the nerve, which are the epineurium and perineurium. There is degeneration of the Wallerian tissue so that an electromyogram done two to four weeks out of the injury will show fibrillations and what’s called "denervation potentials" past the point of injury. Both motor and sensory nerve damage occurs and is much more complete than with neuropraxia. The repair practice takes a long time but it usually occurs.

Axonotmesis usually happens following a severe crush injury or contusion. Stretching of the nerve can cause this type of injury as well. The nerve degenerates in a retrograde fashion—something that must be fixed first before regeneration can begin. Proximal lesions can grow as quickly as 2-3 mm per day while distal lesions only grow 1.5 mm per day. It takes month to years to recover from this type of injury.

Neurotmesis is the most severe nerve lesion with the least chance of recovery. It can occur with local anesthetic toxicity, laceration of a nerve, a severe contusion or stretching of the nerve. The axon, myelin and surrounding connective tissue are damaged. The most extreme degree of this type of lesion is transection of the nerve. There is internal disruption of the nerve’s architecture so that the perineurium and epineurium are disrupted. EMG shows denervation changes in the nerve. A neuroma can form in the nerve at the proximal stump.

Surgeons can transect nerves in surgery, leading to a loss of function past the nerve’s transection. An obstetrician can pull on a fetus’ head in a difficult delivery so that the brachial plexus, a bundle of nerves exiting the spine, can become temporarily or permanently damaged. There can be a prolonged compression of a nerve while doing surgery and using retractors. This can temporarily or permanently damage the nerve.

In regeneration of the nerve, it needs to be remyelinated. Then there must be regeneration of neurons, glia, synapses and axons. There are differences in the way the peripheral nervous system regenerates and the way the central nervous system regenerates. Younger people regenerate nerves faster than older people.


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