Clinical aspects of nerve injury

Abstract

In the acute injury the object of the clinician must be to recognise the fact of injury as soon as possible after the event, and later to go on to determine the nerve or nerves affected, the level or levels of injury and the extent and depth of the lesion or lesions. That this is not always easy nor always appreciated is apparent to anyone who has been able to study the records of the medical defense organisations. The history is important: high velocity injury, compound fracture and wounding, accidental, criminal, surgical or all three, are likely to mean that there has been a serious lesion. The use of a knife, often enough in the hand of a surgeon, is an indication that a nerve is likely to have been partly or completely severed. Advice from witnesses or emergency paramedical staff is always valuable. Potentially life or limb threatening injuries complicate closed traction lesion of the supraclavicular brachial plexus in at least 20% of cases. Even more patients with injuries to the lumbo-sacral plexus are so threatened. The subclavian artery is ruptured in 10% of complete lesions of the brachial plexus and in as many as 30% of cases of violent traction injury of the infraclavicular portion of the brachial plexus. The incidence of arterial lesion is high after fracture dislocations of the shoulder and elbow, higher still after fracture dislocations of the knee. It is important always to search with diligence for occult injuries to the head, the spine, the chest, the abdomen and pelvis before embarking upon treatment of the nerve lesion, both at the first hospital but also after transfer to another Unit (Fig. 5.1). © 2011 Springer-Verlag London Limited.