Materiały źródłowe

• #1 Peripheral nerve injuries – Symptoms and causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/peripheral-nerve-injuries/symptoms-causes/syc-20355631

  It’s important to get medical care for a peripheral nerve injury as soon as possible. Early diagnosis and treatment may prevent complications and permanent damage. […] If you experience weakness, tingling, numbness or a total loss of feeling, see your healthcare professional to find out the cause. It’s important to treat peripheral nerve injuries early.

• #2 Peripheral nerve injuries // Middlesex Health

  https://middlesexhealth.org/learning-center/diseases-and-conditions/peripheral-nerve-injuries

  It’s important to get medical care for a peripheral nerve injury as soon as possible. Early diagnosis and treatment may prevent complications and permanent damage. […] To diagnose peripheral nerve injuries, your healthcare professional reviews your medical history. You’re asked about any accidents or previous surgeries you’ve had and about your symptoms. Your healthcare professional also conducts a physical and neurological exam. If there are symptoms of a nerve injury, you may need diagnostic tests, which may include: […] Many tests may be used to help diagnose the type and severity of peripheral nerve injury.

• #3 Traumatic peripheral nerve injuries: diagnosis and management – PubMed

  https://pubmed.ncbi.nlm.nih.gov/36367041/

  Purpose of review: To review advances in the diagnostic evaluation and management of traumatic peripheral nerve injuries. […] Serial multimodal assessment of peripheral nerve injuries facilitates assessment of spontaneous axonal regeneration and selection of appropriate patients for early surgical intervention. […] Innovative approaches to the assessment and treatment of peripheral nerve injuries hold promise in improving the degree of functional recovery; however, this remains a complex and evolving area.

• #4 Peripheral nerve injuries – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/peripheral-nerve-injuries/diagnosis-treatment/drc-20355632

  To diagnose peripheral nerve injuries, your healthcare professional reviews your medical history. You’re asked about any accidents or previous surgeries you’ve had and about your symptoms. Your healthcare professional also conducts a physical and neurological exam. If there are symptoms of a nerve injury, you may need diagnostic tests, which may include: […] Electromyography (EMG). In an EMG, a thin-needle electrode inserted into the muscle records the muscle’s electrical activity at rest and in motion. Reduced muscle activity can suggest nerve injury. […] Nerve conduction study. Electrodes placed at two different points in the body measure how well electrical signals pass through the nerves. […] Magnetic resonance imaging (MRI). MRI uses a magnetic field and radio waves to produce detailed images of areas affected by nerve damage.

• #5 Peripheral Nerve Injury – Barrow Neurological InstituteSecond Opinion IconSecond Opinion IconSpine Surgery

  https://www.barrowneuro.org/condition/peripheral-nerve-injury/

  Peripheral nerve injuries are typically diagnosed through a combination of physical examination, medical history, and diagnostic tests. […] During a physical examination, your healthcare provider will evaluate the affected area for signs of injury, such as swelling, tenderness, or weakness. […] Diagnostic tests may include: Electromyography (EMG) and nerve conduction studies, which measure the electrical activity in muscles and nerves to assess their function. […] The specific tests used to diagnose a peripheral nerve injury will depend on the location and severity of the injury and the underlying cause.

• #6 Peripheral Neuropathy: What It Is, Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/14737-peripheral-neuropathy

  Diagnosing peripheral neuropathy usually involves a combination of methods. These include: […] Symptoms and medical history. Your healthcare provider will likely ask questions about your medical history and any recent symptoms or changes you’ve noticed. They may also ask about other medical conditions and factors, such as type 2 diabetes, and your nutrition, habits and lifestyle. […] Physical and neurological exams. These involve a healthcare provider looking for physical signs of peripheral neuropathy, including changes in your ability to feel sensations, muscle weakness, changes in your reflexes or trouble with walking and balance. […] Lab, diagnostic and imaging tests. A wide range of tests can help with diagnosing peripheral neuropathy. […] The most common types of tests for peripheral neuropathy (either to confirm the diagnosis or rule out other conditions) include: […] Blood tests (these can detect many problems, ranging from immune system problems to toxins and poisons, especially metals like mercury or lead). […] Electromyogram. […] Nerve ultrasound. […] Nerve biopsy. […] Genetic testing. […] Magnetic resonance imaging (MRI).

• #7 Acute Nerve Injury Workup: Laboratory Studies, Imaging Studies, Other Tests

  https://emedicine.medscape.com/article/249621-workup

  The workup of every patient with acute nerve injury begins with a complete history and a physical examination. The site of injury can be accurately localized from a precise neurologic examination. […] Routine electrodiagnostic testing can be used to support a clinical suspicion of nerve injury or to evaluate the nerve function in patients in whom a reliable neurologic examination is impossible. […] Differentiating between a peripheral nerve problem and an injury involving the spinal cord, brain, bone, or soft tissue is crucial. […] As part of the physical examination, the strength of individual muscles or of muscle groups is graded. Additionally, a sensory examination is performed, which includes testing for light touch, pinprick, 2-point discrimination, vibration, and proprioception.

• #8 Peripheral Nerve Entrapment and Injury in the Upper Extremity | AAFP

  https://www.aafp.org/pubs/afp/issues/2010/0115/p147.html

  Nerve injury should be considered when a patient reports pain, weakness, or paresthesias that are not related to a known bone, soft tissue, or vascular injury. […] The initial examination should focus on the neck, with palpation of the cervical vertebrae to detect point tenderness and evaluation of neck range of motion. […] If motor symptoms occur, the upper extremity muscle group exhibiting weakness correlates with the part of the brachial plexus that has been injured. […] Electrodiagnostic testing consists of nerve conduction studies and electromyography (EMG). Nerve conduction studies assess the integrity of sensory and motor nerves. […] Electrodiagnostic testing is commonly used to evaluate for carpal tunnel syndrome and cubital tunnel syndrome.

• #9 Peripheral neuropathy – Wikipedia

  https://en.wikipedia.org/wiki/Peripheral_neuropathy

  Peripheral neuropathy may first be considered when an individual reports symptoms of numbness, tingling, and pain in feet. After ruling out a lesion in the central nervous system as a cause, a diagnosis may be made on the basis of symptoms, laboratory and additional testing, clinical history, and a detailed examination. […] During physical examination, specifically a neurological examination, those with generalized peripheral neuropathies most commonly have distal sensory or motor and sensory loss, although those with a pathology (problem) of the nerves may be perfectly normal; may show proximal weakness, as in some inflammatory neuropathies, such as GuillainBarr syndrome; or may show focal sensory disturbance or weakness, such as in mononeuropathies. Classically, ankle jerk reflex is absent in peripheral neuropathy.

• #10 classification and diagnostic methods of peripheral nerve injury | PPT

  https://www.slideshare.net/slideshow/classification-and-diagnostic-methods-of-peripheral-nerve-injury/236461050

  This document discusses peripheral nerve injury, including classifications, diagnosis, and treatment. […] Diagnosis involves clinical exams, imaging like ultrasound and MRI, and electrodiagnostic tests like nerve conduction studies and electromyography. […] Diagnosis of peripheral nerve injury. Clinical diagnosis 1. In the upper extremities :- a. Loss of pain perception at the tip of little finger indicates ulnar nerve injury. b. Loss of pain perception at the tip of index finger indicates median nerve injury. c. Inability to extend the thumb in hitchhiker sign indicates radial nerve injury. 2.In the lower extremities :- a. Loss of pain perception in sole of foot indicates sciatic or tibial nerve inury. b. Inability to extend the great toe or foot indicates peroneal or sciatic nerve injury.

• #11

  https://journals.lww.com/neur/fulltext/2019/67060/peripheral_nerve_injuries__electrophysiology_for.5.aspx

  Peripheral nerve injuries are a heterogeneous and distinct group of disorders that are secondary to various causes commonly including motor vehicle accidents, falls, industrial accidents, household accidents, and penetrating trauma. […] The electrophysiological studies including nerve conduction studies (NCS) and electromyography (EMG) play a key role and are now considered an extension of the clinical examination in patients with peripheral nerve injuries. […] An early diagnosis and management are important to improve the functional outcome in these patients, and hence, it is important to identify the associated nerve injury. Electrophysiological studies play a key role in peripheral nerve injuries and are useful in lesion localization, determining the type and severity of injury, and prognostication.

• #12

  https://journals.lww.com/neur/fulltext/2019/67060/peripheral_nerve_injuries__electrophysiology_for.5.aspx

  Electrophysiological studies play a key role and are considered an extension of the clinical examination in patients with peripheral nerve injuries. The electrophysiological results should be interpreted in the light of clinical examination. Nerve conduction studies (NCS) and electromyography (EMG) are often used to evaluate such patients. The principal goals of the electrodiagnostic studies are localization of the lesion, determination of the type of injury and its severity, and prognostication. […] Intraoperative monitoring also helps in identifying the nerve close to an ongoing surgery so that surgical damage to the nerve can be prevented. […] Intraoperative recordings help in identifying the nerve injured and to determine whether the nerve is in continuity.

• #13 Peripheral Nerve Entrapment and Injury in the Upper Extremity | AAFP

  https://www.aafp.org/pubs/afp/issues/2021/0301/p275.html

  The primary diagnostic tests for evaluation of nerve injury and entrapment include electrodiagnostic tests, subdivided into nerve conduction studies and electromyography (EMG), and imaging, which includes magnetic resonance imaging and ultrasonography. […] Electrodiagnostic testing is helpful to confirm the diagnosis, determine severity, and monitor progression of nerve damage. […] Magnetic resonance imaging and ultrasonography are used for evaluating deeper soft tissue pathology and bony abnormality compressing a nerve or for increased signal and nerve thickness indicative of nerve injury.

• #14 Peripheral nerve injuries – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/peripheral-nerve-injuries/diagnosis-treatment/drc-20355632

  To diagnose peripheral nerve injuries, your healthcare professional reviews your medical history. You’re asked about any accidents or previous surgeries you’ve had and about your symptoms. Your healthcare professional also conducts a physical and neurological exam. If there are symptoms of a nerve injury, you may need diagnostic tests, which may include: […] Electromyography (EMG). In an EMG, a thin-needle electrode inserted into the muscle records the muscle’s electrical activity at rest and in motion. Reduced muscle activity can suggest nerve injury. […] Nerve conduction study. Electrodes placed at two different points in the body measure how well electrical signals pass through the nerves. […] Magnetic resonance imaging (MRI). MRI uses a magnetic field and radio waves to produce detailed images of areas affected by nerve damage.

• #15 Peripheral Nerve Injuries – Golden State Orthopedics & Spine

  https://www.goldenstateortho.com/peripheral-nerve-injuries/

  Electromyography (EMG) evaluates the electrical activity of muscles. It can detect abnormalities in muscle function that may result from nerve damage. This test is particularly useful in identifying denervation (loss of nerve supply) and assessing the severity of the injury. […] Understanding and diagnosing peripheral nerve injuries are crucial for effective management. Electrodiagnostic tests, such as NCS and EMG, serve as indispensable tools in this process, offering valuable insights into the location and severity of nerve injuries caused by compression, entrapment, or trauma. Early and accurate diagnosis enables healthcare professionals to develop targeted treatment plans, improving the overall outcome for orthopedic patients with peripheral nerve injuries.

• #16 Clinical neurophysiology and imaging of nerve injuries: preoperative diagnostic work-up and postoperative monitoring

  https://www.oaepublish.com/articles/2347-9264.160877

  In order to reveal axonal loss (presence of denervation potentials), the optimal timing of a neurodiagnostic study is 2-3 weeks after injury. […] Nerve conduction studies are the first line studies in instrumental evaluation of nerve injuries. […] The amplitude of the evoked response estimates the quantity of depolarized motor or sensory fibers, while conduction velocity measures the speed of the fastest (and large caliber) motor or sensory myelinated axons. […] In the case of axonotmesis and neurotmesis, after distal axonal degeneration (which completes in 3-5 days for motor fibers and in 6-10 days for sensory fibers), CMAP and SNAP are reduced in amplitude when stimulating distally to the injury; the ratio between CMAP/SNAP amplitudes on the injured side to the CMAP/SNAP of the normal side is a good estimate of the degree of axonal loss.

• #17 Peripheral nerve injuries – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/peripheral-nerve-injuries/diagnosis-treatment/drc-20355632

  To diagnose peripheral nerve injuries, your healthcare professional reviews your medical history. You’re asked about any accidents or previous surgeries you’ve had and about your symptoms. Your healthcare professional also conducts a physical and neurological exam. If there are symptoms of a nerve injury, you may need diagnostic tests, which may include: […] Electromyography (EMG). In an EMG, a thin-needle electrode inserted into the muscle records the muscle’s electrical activity at rest and in motion. Reduced muscle activity can suggest nerve injury. […] Nerve conduction study. Electrodes placed at two different points in the body measure how well electrical signals pass through the nerves. […] Magnetic resonance imaging (MRI). MRI uses a magnetic field and radio waves to produce detailed images of areas affected by nerve damage.

• #18 Clinical neurophysiology and imaging of nerve injuries: preoperative diagnostic work-up and postoperative monitoring

  https://www.oaepublish.com/articles/2347-9264.160877

  In order to reveal axonal loss (presence of denervation potentials), the optimal timing of a neurodiagnostic study is 2-3 weeks after injury. […] Nerve conduction studies are the first line studies in instrumental evaluation of nerve injuries. […] The amplitude of the evoked response estimates the quantity of depolarized motor or sensory fibers, while conduction velocity measures the speed of the fastest (and large caliber) motor or sensory myelinated axons. […] In the case of axonotmesis and neurotmesis, after distal axonal degeneration (which completes in 3-5 days for motor fibers and in 6-10 days for sensory fibers), CMAP and SNAP are reduced in amplitude when stimulating distally to the injury; the ratio between CMAP/SNAP amplitudes on the injured side to the CMAP/SNAP of the normal side is a good estimate of the degree of axonal loss.

• #19 Acute Nerve Injury Workup: Laboratory Studies, Imaging Studies, Other Tests

  https://emedicine.medscape.com/article/249621-workup

  Imaging techniques, such as radiography, computed tomography (CT) scan, and magnetic resonance imaging (MRI) are valuable diagnostic tools for evaluating a peripheral nerve lesion. […] Numerous clinical studies have used magnetic resonance neurography (MRN) to examine patients with peripheral nerve pathology. […] Assessment of peripheral nerve injury in patients using this technique has the potential to confirm acute nerve injury and monitor the recovery process. […] An NCS is effective for evaluating peripheral nerve injury. […] An NCS is useful for distinguishing neurapraxic from more severe grades of injury. […] The hallmark of a neurapraxic injury is slowing or block of conduction across a section of nerve. The absence of nerve conduction distal to the injury indicates axonal loss related to a more severely graded injury.

• #20 Imaging diagnosis in peripheral nerve injury

  https://pmc.ncbi.nlm.nih.gov/articles/PMC10539591/

  Peripheral nerve injuries (PNIs) can be caused by various factors, ranging from penetrating injury to compression, stretch and ischemia, and can result in a range of clinical manifestations. […] Imaging plays a crucial role in the precise orientation and planning of surgical interventions, as well as in monitoring the progression of the injury and evaluating treatment outcomes. […] Currently, a variety of imaging modalities including ultrasound (US), computed tomography (CT) and magnetic resonance imaging (MRI) and positron emission tomography (PET) have been applied in detection and diagnosis of PNIs, and the imaging efficiency and accuracy many vary based on the nature of injuries and severity. […] Radiological imaging is a crucial tool in the diagnosis of peripheral nerve injuries. MRI, ultrasound, and CT scans are all commonly used modalities in this process. Each of these imaging techniques provides unique benefits and can help identify the location and severity of nerve damage.

• #21 State-of-the-Art Diagnosis of Peripheral Nerve Trauma: Clinical Examination, Electrodiagnostic, and Imaging | SpringerLink

  https://link.springer.com/chapter/10.1007/978-3-319-52319-4_2

  While history taking and physical examination are requisites for the diagnosis of peripheral nerve trauma, electrodiagnostic and imaging methods, namely, electromyography, nerve conduction studies, high-resolution ultrasound, and magnetic resonance neurography, also are necessary. […] The latter are required to determine the exact site of the nerves lesion and especially to determine its type (neurapraxia, axonotmesis, neurotmesis), which is essential for any therapeutic decision. […] They also are valuable for monitoring the nerves regeneration after therapy. […] The diagnostic value of the mentioned methods is reviewed in this chapter, with a special view to the time course of their results after a nerve trauma.

• #22 Imaging diagnosis in peripheral nerve injury

  https://pmc.ncbi.nlm.nih.gov/articles/PMC10539591/

  Ultrasound (US) is a safe and time-effective non-invasive imaging modality often applied in the diagnosis and management of peripheral nerve injuries. […] In comparison with electro-diagnostics, US not only identified nerve injuries but also accurately localized the injuries, determined their severity, identified the presence of neuromas or stumps, and detected the formation of perineural scar tissue pre- and intraoperatively. […] CT scan is mainly useful for identifying bony abnormalities that may be contributing to nerve injuries, such as bone spurs, fractures, or joint dislocations. […] Magnetic resonance imaging (MRI) is a non-invasive imaging based diagnostic tool that can be employed to detect peripheral nerve injury. […] MRI can help diagnose peripheral nerve injury by providing detailed images of the nerves and surrounding tissues.

• #23 Clinical neurophysiology and imaging of nerve injuries: preoperative diagnostic work-up and postoperative monitoring

  https://www.oaepublish.com/articles/2347-9264.160877

  Neurophysiological investigation offers information on the pathophysiology of the nerve deficit, the grade of severity, and prognosis. […] Imaging assessment, in particular high-resolution ultrasound (HRU) and magnetic resonance imaging (MRI), may overcome these problems by providing information on nerve morphology and its surrounding tissues; these are becoming popular instruments for planning nerve reconstruction and the surgical approach. […] HRU currently represents the most easily available and practical imaging technique for investigation of peripheral nerve pathology. […] Neurophysiological and clinical parameters are good predictors of postsurgical recovery, but HRU has also demonstrated its usefulness when correlated with clinical neurophysiology in several nerve pathologies.

• #24 Assessment of Motor Function in Peripheral Nerve Injury and Recovery | Published in Orthopedic Reviews

  https://orthopedicreviews.openmedicalpublishing.org/article/37578-assessment-of-motor-function-in-peripheral-nerve-injury-and-recovery

  In conditions where NCS has demonstrated high sensitivity, there are other gold-standard measuring tools that are simpler and more cost-effective. […] Consequently, NCS should be used in cases where results of more common clinical tests are unclear and less as a first line diagnostic tool. […] When the status of nerve function and/or recovery is unclear after sensory and/or motor testing in clinic, EMGs may be used as an adjunct to help determine the extent of motor dysfunction. […] MRN to provide additional data when common clinic tests and are inconclusive. […] It is currently the gold standard for imaging of compressive neuropathy. […] The JTHFT can be used to clinically assess patients hand functions and to distinguish between impaired and unimpaired hand function in assessing nerve injury. […] This review serves as a centralized reservoir of knowledge for surgeons to develop their own optimal systems. […] By improving the motor assessment algorithm, surgeons can better track and offer additional intervention for patients with peripheral nerve injuries.

• #25 Imaging diagnosis in peripheral nerve injury

  https://pmc.ncbi.nlm.nih.gov/articles/PMC10539591/

  Ultrasound (US) is a safe and time-effective non-invasive imaging modality often applied in the diagnosis and management of peripheral nerve injuries. […] In comparison with electro-diagnostics, US not only identified nerve injuries but also accurately localized the injuries, determined their severity, identified the presence of neuromas or stumps, and detected the formation of perineural scar tissue pre- and intraoperatively. […] CT scan is mainly useful for identifying bony abnormalities that may be contributing to nerve injuries, such as bone spurs, fractures, or joint dislocations. […] Magnetic resonance imaging (MRI) is a non-invasive imaging based diagnostic tool that can be employed to detect peripheral nerve injury. […] MRI can help diagnose peripheral nerve injury by providing detailed images of the nerves and surrounding tissues.

• #26 Imaging diagnosis in peripheral nerve injury

  https://pmc.ncbi.nlm.nih.gov/articles/PMC10539591/

  The benefits of using MRI for diagnosing peripheral nerve injury include its non-invasive nature and its ability to provide detailed images of soft tissues. […] As a primary symptom of PNIs, allodynia could occur without significant changes in nerve morphology, adding to difficulty for diagnosis by US or MRI. […] While PET imaging in PNIs is accurate, available with various ligands, and can detect in absence of significant morphological changes, it is still limited by side-effects associated with radiopharmaceutical, and relatively low affordability compared with electromyography, US and MRI. […] In summary, magnetic resonance imaging is an effective tool for diagnosing peripheral nerve injury. It provides detailed images of nerves and surrounding tissues without requiring any invasive procedures.

• #27 Diagnosis and Repair of Peripheral Nerve Injuries | Musculoskeletal Key

  https://musculoskeletalkey.com/diagnosis-and-repair-of-peripheral-nerve-injuries/

  The timing of presentation relative to injury is key. […] A conduction block or neurapraxia should be expected to improve by 6 to 12 weeks from injury. […] Nerve conduction testing is performed by stimulating nerves and recording their response and tests only the large, myelinated fibers of a nerve. […] Ultrasonography (USG) is gaining popularity as a cost-effective modality to evaluate peripheral nerve injuries. […] Magnetic resonance neurography (MRN) is useful to determine continuity of nerves and presence of neuroma and examine for neuritis.

• #28 Updates in peripheral nerve surgery of the upper extremity: diagnosis and treatment options

  https://atm.amegroups.org/article/view/117543/html

  MRI is now commonplace in most centres. While it does offer excellent anatomical delineation which can be useful for pre-operative planning, one may not have adequate time afforded for a scan in a time-critical emergency, and obtaining a scan after office hours may not be possible. […] The role of MRI in diagnostic and post-operative monitoring is still fraught with uncertainties including the optimal timeline for performing a scan, when the signal change from a nerve lesion becomes appreciable, and whether the MRI signal evoked by the nerve after a lesion can return to normal without surgical intervention. […] MRN does not reveal pathophysiologic information about functional integrity of axons in peripheral nerves. However, this can theoretically be overcome with functional MRI techniques like diffusion-weighted imaging (DWI) or diffusion tensor imaging (DTI) which provide objective quantitative information on the physiopathologic status of the involved peripheral nerve segment, including nerve viability and tension of a repair.

• #29 Imaging diagnosis in peripheral nerve injury

  https://pmc.ncbi.nlm.nih.gov/articles/PMC10539591/

  Ultrasound (US) is a safe and time-effective non-invasive imaging modality often applied in the diagnosis and management of peripheral nerve injuries. […] In comparison with electro-diagnostics, US not only identified nerve injuries but also accurately localized the injuries, determined their severity, identified the presence of neuromas or stumps, and detected the formation of perineural scar tissue pre- and intraoperatively. […] CT scan is mainly useful for identifying bony abnormalities that may be contributing to nerve injuries, such as bone spurs, fractures, or joint dislocations. […] Magnetic resonance imaging (MRI) is a non-invasive imaging based diagnostic tool that can be employed to detect peripheral nerve injury. […] MRI can help diagnose peripheral nerve injury by providing detailed images of the nerves and surrounding tissues.

• #30

  https://www.vin.com/apputil/content/defaultadv1.aspx?pId=11196&catId=30758&id=3854283

  Motor nerve conduction velocity (MNCV) and the recorded amplitudes of muscle evoked action potentials provide an accurate evaluation of the severity of the damage to the LMN. Sensory function can be assessed by means of sensory nerve conduction velocity (SNCV) study and cord dorsum potential (CDP). […] Survey radiographs are indicated when the nerve injury is likely to be associated with fractures (i.e., humeral, femoral, pelvic, sacrocaudal) or with intramedullary pinning. Ultrasound may be helpful in assessing nerve anatomy and further characterise traumatic nerve lesions in companion animals. […] Computerized tomographic (CT)–myelography is indicated in the diagnosis of brachial plexus nerve root avulsion since it allows visualization of meningeal diverticula and abnormalities of the spinal nerve roots. MRI provides fine anatomic detail of soft tissue and can be used to visualise nerve structures. […] These advanced diagnostic imaging techniques may have an important role in the assessment of peripheral nerve and brachial plexus injuries in companion animals in the near future.

• #31 Peripheral Neuropathy: What It Is, Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/14737-peripheral-neuropathy

  Diagnosing peripheral neuropathy usually involves a combination of methods. These include: […] Symptoms and medical history. Your healthcare provider will likely ask questions about your medical history and any recent symptoms or changes you’ve noticed. They may also ask about other medical conditions and factors, such as type 2 diabetes, and your nutrition, habits and lifestyle. […] Physical and neurological exams. These involve a healthcare provider looking for physical signs of peripheral neuropathy, including changes in your ability to feel sensations, muscle weakness, changes in your reflexes or trouble with walking and balance. […] Lab, diagnostic and imaging tests. A wide range of tests can help with diagnosing peripheral neuropathy. […] The most common types of tests for peripheral neuropathy (either to confirm the diagnosis or rule out other conditions) include: […] Blood tests (these can detect many problems, ranging from immune system problems to toxins and poisons, especially metals like mercury or lead). […] Electromyogram. […] Nerve ultrasound. […] Nerve biopsy. […] Genetic testing. […] Magnetic resonance imaging (MRI).

• #32 Peripheral Neuropathy | MedlinePlus

  https://medlineplus.gov/peripheralnervedisorders.html

  How are peripheral nerve disorders diagnosed? […] To find out if you have a peripheral nerve disorder, your provider will: […] Order tests, which may include: […] Blood tests […] Genetic tests […] Nerve tests that measure: […] Electrical activity in your nerves and muscles […] How well your autonomic nerves are working […] A biopsy of nerve or skin tissue […] CT or MRI scan to see what may be pressing on your nerves.

• #33 Diagnosing Peripheral Neuropathy | NYU Langone Health

  https://nyulangone.org/conditions/peripheral-neuropathy/diagnosis

  Diagnosing peripheral neuropathy can be difficult because the symptoms vary according to the nerves involved and may be vague or overlap with those associated with other conditions. […] During this exam, a doctor evaluates your mental and emotional state and your ability to communicate; your movement, muscle strength, coordination, and balance; and your vision and other senses. The doctor also tests your ability to sense vibration, light touch, body position, temperature, and pain. Testing the senses can reveal sensory nerve damage and indicate the nerves affected. […] A blood test can detect conditions that may be causing peripheral neuropathy, such as diabetes, nutrient deficiencies, liver or kidney dysfunction, and abnormal immune system activity. […] A doctor may order a nerve conduction study, which can reveal if you have nerve damage. The study measures how quickly an electrical impulse travels through a nerve and how much of the impulse is transmitted.

• #34 Diagnosing Peripheral Neuropathy | NYU Langone Health

  https://nyulangone.org/conditions/peripheral-neuropathy/diagnosis

  An electromyogram evaluates how the nerves and muscles work together by measuring electrical impulses along nerves, nerve roots, and muscles. […] During a skin biopsy, a small piece of skin is removed, and nerve fiber endings are examined under a microscope. This test can help a doctor identify whether the nerves are damaged, causing sensory loss.

• #35 Peripheral Nerve Disorders | Memorial Hermann

  https://memorialhermann.org/services/conditions/peripheral-nerve-disorders

  Patients come from across the country to be diagnosed and treated for an array of peripheral nerve disorders at the Mischer Neuroscience Institute. […] A peripheral nerve disorder specialist can use the following tests to identify a nerve disorder: […] Electromyography (EMG) involves inserting a fine needle into a muscle to compare the level of electrical activity present when muscles are at rest and when they contract. EMG can help differentiate between muscle and nerve disorders. […] Nerve conduction velocity (NCV) testing can precisely measure the degree of damage in larger nerve fibers, revealing whether symptoms are being caused by degeneration of the myelin sheath or the axon. […] Nerve biopsy involves removing and examining a sample of nerve tissue, most often in the lower leg.

• #36 Peripheral Nerve Disorders | Memorial Hermann

  https://memorialhermann.org/services/conditions/peripheral-nerve-disorders

  Skin biopsy offers unique advantages over NCV tests and nerve biopsy. Unlike NCV, it can reveal damage present in smaller fibers; in contrast to conventional nerve biopsy, skin biopsy is less invasive, has fewer side effects and is easier to perform. […] Lumbar puncture may be used when immune-mediated polyneuropathies, cryptogenic axonal degeneration polyneuropathies or infections or inflammatory disorders are suspected.

• #37

  https://journals.lww.com/neur/fulltext/2019/67060/peripheral_nerve_injuries__electrophysiology_for.5.aspx

  Electrophysiological studies play a key role and are considered an extension of the clinical examination in patients with peripheral nerve injuries. The electrophysiological results should be interpreted in the light of clinical examination. Nerve conduction studies (NCS) and electromyography (EMG) are often used to evaluate such patients. The principal goals of the electrodiagnostic studies are localization of the lesion, determination of the type of injury and its severity, and prognostication. […] Intraoperative monitoring also helps in identifying the nerve close to an ongoing surgery so that surgical damage to the nerve can be prevented. […] Intraoperative recordings help in identifying the nerve injured and to determine whether the nerve is in continuity.

• #38 Peripheral Nerve Entrapment and Injury in the Upper Extremity | AAFP

  https://www.aafp.org/pubs/afp/issues/2021/0301/p275.html

  Peripheral nerves in the upper extremities are at risk of injury and entrapment because of their superficial nature and length. Injury can result from trauma, anatomic abnormalities, systemic disease, and entrapment. The extent of the injury can range from mild neurapraxia, in which the nerve experiences mild ischemia caused by compression, to severe neurotmesis, in which the nerve has full-thickness damage and full recovery may not occur. […] A detailed history and physical examination alone are often enough to identify the injury or entrapment; advanced diagnostic testing with magnetic resonance imaging, ultrasonography, or electrodiagnostic studies can help confirm the clinical diagnosis and is indicated if conservative management is ineffective. […] Electrodiagnostic testing should be used as an adjunct to physical examination and imaging to help confirm the diagnosis of peripheral nerve injury, establish the severity of injury, and monitor progression of nerve damage.

• #39

  https://www.orthobullets.com/hand/6066/peripheral-nerve-injury-and-repair

  Peripheral nerve injury is a relatively common condition that encompasses a range of reversible and irreversible impairments determined by injury level, axonal disruption, and time to treatment. […] Diagnosis is typically clinical with a combination of known injury with a nerve deficit. Advanced imaging such as ultrasound or MRI may be used to characterize nerve morphology after injury; however, EMG/NCS is a mainstay of evaluating both nerve injury and nerve recovery. Surgical exploration is confirmatory for traumatic nerve injuries. […] Prognosis with treatment is variable on several factors including injury location, age of patient, and type of injury; neurapraxia resolves with conservative measures; axonotmesis and neurotmesis may improve with repair, tendon transfers, and/or nerve transfers; the endoneurium must be intact for full recovery of an injured peripheral nerve.

• #40 Diagnosis and Repair of Peripheral Nerve Injuries | Musculoskeletal Key

  https://musculoskeletalkey.com/diagnosis-and-repair-of-peripheral-nerve-injuries/

  The timing of presentation relative to injury is key. […] A conduction block or neurapraxia should be expected to improve by 6 to 12 weeks from injury. […] Nerve conduction testing is performed by stimulating nerves and recording their response and tests only the large, myelinated fibers of a nerve. […] Ultrasonography (USG) is gaining popularity as a cost-effective modality to evaluate peripheral nerve injuries. […] Magnetic resonance neurography (MRN) is useful to determine continuity of nerves and presence of neuroma and examine for neuritis.

• #41 Clinical neurophysiology and imaging of nerve injuries: preoperative diagnostic work-up and postoperative monitoring

  https://www.oaepublish.com/articles/2347-9264.160877

  Peripheral nerve injuries are a heterogeneous group of lesions that may occurs secondary to various causes. […] The aim of this review is to provide clinical guidelines for the diagnosis of nerve injuries, and the rationale for instrumental evaluation in the preoperative and postoperative periods. […] No clinical evaluation can distinguish neurapraxia from axonotmesis, and no clinical or neurophysiological examination can distinguish axonotmesis from neurotmesis. To obtain the correct diagnosis and a plan appropriate to treatment, both neurophysiological and imaging studies and clinical re-evaluation over time are often required. […] Clinical neurophysiological examination is currently the gold standard for diagnosis and determination of prognosis in peripheral nerve injuries, in order to localize and quantify clinical and subclinical preoperative damage and postoperative recovery.

• #42 Peripheral nerve injuries – Symptoms and causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/peripheral-nerve-injuries/symptoms-causes/syc-20355631

  It’s important to get medical care for a peripheral nerve injury as soon as possible. Early diagnosis and treatment may prevent complications and permanent damage. […] If you experience weakness, tingling, numbness or a total loss of feeling, see your healthcare professional to find out the cause. It’s important to treat peripheral nerve injuries early.

• #43 Peripheral nerve injuries // Middlesex Health

  https://middlesexhealth.org/learning-center/diseases-and-conditions/peripheral-nerve-injuries

  It’s important to get medical care for a peripheral nerve injury as soon as possible. Early diagnosis and treatment may prevent complications and permanent damage. […] To diagnose peripheral nerve injuries, your healthcare professional reviews your medical history. You’re asked about any accidents or previous surgeries you’ve had and about your symptoms. Your healthcare professional also conducts a physical and neurological exam. If there are symptoms of a nerve injury, you may need diagnostic tests, which may include: […] Many tests may be used to help diagnose the type and severity of peripheral nerve injury.

• #44 Peripheral Nerve Injury | Boston Children’s Hospital

  https://www.childrenshospital.org/conditions/peripheral-nerve-injury

  Nerve injuries interfere with these signals and can lead to a loss of movement or feeling in the affected area. […] If you suspect your child has nerve damage, it’s important to bring them to a doctor who specializes in nerve repair as soon as possible. New techniques have made it possible to repair damaged nerves and restore full or partial function to the affected muscles. […] If your child has weakness, numbness, or lost feeling or function, seek prompt medical care. […] Diagnosing a nerve injury begins with a physical exam. The doctor will ask your child to move their arm or leg so they can look for signs of reduced mobility. One or more of the following tests may help identify nerve damage and the extent of the injury: Nerve conduction studies (NCS) and electromyography (EMG), Magnetic resonance imaging (MRI), Ultrasound imaging.

• #45 Peripheral Nerve Injury | Boston Children’s Hospital

  https://www.childrenshospital.org/conditions/peripheral-nerve-injury

  Your child’s treatment will depend on their symptoms and the severity of the injury. If their nerve was stretched or compressed, the injury may heal with minimal treatment. Regular follow-up visits are important so your child’s doctor can make sure the nerve continues to recover. […] Severely damaged nerves and nerves that have been ruptured or cut can sometimes be repaired with surgery. Nerve repair surgery creates a new pathway for signals to travel to and from the brain and the muscle. […] Nerves grow much more slowly than bones and muscles, therefore, recovery from nerve repair surgery can take up to two years. Physical therapy will help your child’s brain learn how to communicate with the muscle through the new pathway. […] As a national and international referral center for brachial plexus injury, the Hand and Orthopedic Upper Extremity Program has treated hundreds of babies, children, adolescents, and young adults with traumatic nerve injury.

• #46 Acute Nerve Injury Workup: Laboratory Studies, Imaging Studies, Other Tests

  https://emedicine.medscape.com/article/249621-workup

  The workup of every patient with acute nerve injury begins with a complete history and a physical examination. The site of injury can be accurately localized from a precise neurologic examination. […] Routine electrodiagnostic testing can be used to support a clinical suspicion of nerve injury or to evaluate the nerve function in patients in whom a reliable neurologic examination is impossible. […] Differentiating between a peripheral nerve problem and an injury involving the spinal cord, brain, bone, or soft tissue is crucial. […] As part of the physical examination, the strength of individual muscles or of muscle groups is graded. Additionally, a sensory examination is performed, which includes testing for light touch, pinprick, 2-point discrimination, vibration, and proprioception.

• #47 Peripheral Nerve Entrapment and Injury in the Upper Extremity | AAFP

  https://www.aafp.org/pubs/afp/issues/2010/0115/p147.html

  Peripheral nerve injury of the upper extremity commonly occurs in patients who participate in recreational (e.g., sports) and occupational activities. Nerve injury should be considered when a patient experiences pain, weakness, or paresthesias in the absence of a known bone, soft tissue, or vascular injury. […] Plain radiography and magnetic resonance imaging are usually not necessary for initial evaluation of a suspected nerve injury. When pain or weakness is refractory to conservative therapy, further evaluation (e.g., magnetic resonance imaging, electrodiagnostic testing) or surgical referral should be considered. […] Given the potential for longstanding impairment associated with nerve injuries, it is important for the primary care physician to be familiar with their presentation, diagnosis, and management.

• #48 Peripheral Nerve Injury | Boston Children’s Hospital

  https://www.childrenshospital.org/conditions/peripheral-nerve-injury

  Your child’s treatment will depend on their symptoms and the severity of the injury. If their nerve was stretched or compressed, the injury may heal with minimal treatment. Regular follow-up visits are important so your child’s doctor can make sure the nerve continues to recover. […] Severely damaged nerves and nerves that have been ruptured or cut can sometimes be repaired with surgery. Nerve repair surgery creates a new pathway for signals to travel to and from the brain and the muscle. […] Nerves grow much more slowly than bones and muscles, therefore, recovery from nerve repair surgery can take up to two years. Physical therapy will help your child’s brain learn how to communicate with the muscle through the new pathway. […] As a national and international referral center for brachial plexus injury, the Hand and Orthopedic Upper Extremity Program has treated hundreds of babies, children, adolescents, and young adults with traumatic nerve injury.

• #49

  https://journals.lww.com/neur/fulltext/2019/67060/peripheral_nerve_injuries__electrophysiology_for.5.aspx

  Peripheral nerve injuries are a heterogeneous and distinct group of disorders that are secondary to various causes commonly including motor vehicle accidents, falls, industrial accidents, household accidents, and penetrating trauma. […] The electrophysiological studies including nerve conduction studies (NCS) and electromyography (EMG) play a key role and are now considered an extension of the clinical examination in patients with peripheral nerve injuries. […] An early diagnosis and management are important to improve the functional outcome in these patients, and hence, it is important to identify the associated nerve injury. Electrophysiological studies play a key role in peripheral nerve injuries and are useful in lesion localization, determining the type and severity of injury, and prognostication.

• #50 State-of-the-Art Diagnosis of Peripheral Nerve Trauma: Clinical Examination, Electrodiagnostic, and Imaging | SpringerLink

  https://link.springer.com/chapter/10.1007/978-3-319-52319-4_2

  While history taking and physical examination are requisites for the diagnosis of peripheral nerve trauma, electrodiagnostic and imaging methods, namely, electromyography, nerve conduction studies, high-resolution ultrasound, and magnetic resonance neurography, also are necessary. […] The latter are required to determine the exact site of the nerves lesion and especially to determine its type (neurapraxia, axonotmesis, neurotmesis), which is essential for any therapeutic decision. […] They also are valuable for monitoring the nerves regeneration after therapy. […] The diagnostic value of the mentioned methods is reviewed in this chapter, with a special view to the time course of their results after a nerve trauma.

• #51 Clinical neurophysiology and imaging of nerve injuries: preoperative diagnostic work-up and postoperative monitoring

  https://www.oaepublish.com/articles/2347-9264.160877

  Neurophysiological investigation offers information on the pathophysiology of the nerve deficit, the grade of severity, and prognosis. […] Imaging assessment, in particular high-resolution ultrasound (HRU) and magnetic resonance imaging (MRI), may overcome these problems by providing information on nerve morphology and its surrounding tissues; these are becoming popular instruments for planning nerve reconstruction and the surgical approach. […] HRU currently represents the most easily available and practical imaging technique for investigation of peripheral nerve pathology. […] Neurophysiological and clinical parameters are good predictors of postsurgical recovery, but HRU has also demonstrated its usefulness when correlated with clinical neurophysiology in several nerve pathologies.

• #52 Modern MRI Diagnostics of Upper-Extremity-Related Nerve Injuries—A Prospective Multi-Center Study Protocol for Diagnostics and Follow Up of Peripheral Nerve Injuries

  https://www.mdpi.com/2075-4426/12/10/1548

  Improved diagnostics using MR neurography could help to make therapy decisions more precise, thus reducing the duration of sick leave (average 26.8 days) and high therapy costs of more than 300,000 affected Europeans per year. […] Modern MR neurography represents a further development in conventional MR examinations with higher resolution and innovative analysis software. […] This prospective multi-center study examines the clinical application of MR neurography for the optimized primary and follow-up diagnosis of peripheral nerve lesions of the upper extremities. […] The aim of this study is the prospective evaluation of MR neurography for the diagnosis and follow up of the reinnervation process of peripheral nerve lesions of the trunk nerves of the upper extremity. […] This prospective clinical study examines the diagnostic specificity and sensitivity of MR neurography in correlation to the previous standard examinations (gold standard: clinical and intraoperative findings, neurography, and possibly sonography) of acute–traumatic nerve injuries.

• #53 Clinical neurophysiology and imaging of nerve injuries: preoperative diagnostic work-up and postoperative monitoring

  https://www.oaepublish.com/articles/2347-9264.160877

  MRI is appreciated mainly for its wide overview of the limb with the option of selective volume reconstruction. […] Evaluation of peripheral nerve injuries remains a challenge for both clinicians and surgeons. A comprehensive clinical and physical examination approach permits formulation of a differential diagnosis to guide the neurophysiological exam and estimate prognosis.

• #54 Clinical neurophysiology and imaging of nerve injuries: preoperative diagnostic work-up and postoperative monitoring

  https://www.oaepublish.com/articles/2347-9264.160877

  Neurophysiological investigation offers information on the pathophysiology of the nerve deficit, the grade of severity, and prognosis. […] Imaging assessment, in particular high-resolution ultrasound (HRU) and magnetic resonance imaging (MRI), may overcome these problems by providing information on nerve morphology and its surrounding tissues; these are becoming popular instruments for planning nerve reconstruction and the surgical approach. […] HRU currently represents the most easily available and practical imaging technique for investigation of peripheral nerve pathology. […] Neurophysiological and clinical parameters are good predictors of postsurgical recovery, but HRU has also demonstrated its usefulness when correlated with clinical neurophysiology in several nerve pathologies.

• #55 Clinical neurophysiology and imaging of nerve injuries: preoperative diagnostic work-up and postoperative monitoring

  https://www.oaepublish.com/articles/2347-9264.160877

  Neurophysiological investigation offers information on the pathophysiology of the nerve deficit, the grade of severity, and prognosis. […] Imaging assessment, in particular high-resolution ultrasound (HRU) and magnetic resonance imaging (MRI), may overcome these problems by providing information on nerve morphology and its surrounding tissues; these are becoming popular instruments for planning nerve reconstruction and the surgical approach. […] HRU currently represents the most easily available and practical imaging technique for investigation of peripheral nerve pathology. […] Neurophysiological and clinical parameters are good predictors of postsurgical recovery, but HRU has also demonstrated its usefulness when correlated with clinical neurophysiology in several nerve pathologies.

• #56 Modern MRI Diagnostics of Upper-Extremity-Related Nerve Injuries—A Prospective Multi-Center Study Protocol for Diagnostics and Follow Up of Peripheral Nerve Injuries

  https://www.mdpi.com/2075-4426/12/10/1548

  The best treatment for patients suffering is strongly dependent on a multidisciplinary and early diagnosis and treatment. With new technologies such as the MRN, we will accelerate diagnosis and visualize regeneration after treatment. This will improve the outcome due to earlier intervention in cases of non-regeneration.

Zobacz więcej