Peripheral Nerve Injuries

Treatment

Treatment is tailored to each individual, depending on the injury. Following a comprehensive diagnosis of the cause, type and degree of nerve injury, care will involve the following approaches:

Observation

In cases where the nerve is injured but not cut, the surgical team assesses how well the nerve is healing on its own. Surgery may be required to make a precise determination. A nerve that is healing properly does not require surgical repair.

Nerves grow about one inch each month on average, so injured nerves can take up to two years to heal. During that time, the patient will need rehabilitation and careful monitoring and regular checkups to ensure nerve recovery is continuing.

Nerve graft
Nerve tissue can be grafted to fill gaps in damaged nerves.

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Nerve transfer
Nerves can be transferred to fill in for injured nerves.

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Surgery for Nerve Repair

For severed nerves, the surgeon surgically reconnects the nerve ends. An injured nerve may have a section that is damaged beyond repair, or has improperly healed and has scarring. The surgeon will remove the damaged section and reconnect the healthy nerve ends, or reconnect the nerve by implanting a piece of nerve from another part of the body (nerve graft).

With scarred nerves, Mayo surgeons use electromyography (EMG) testing in the operating room to help assess whether the nerve is recovering. EMG testing directly on the nerve in surgery is more accurate and reliable than EMG testing done over the skin.

In select cases, nerves or parts of nerves may be transferred to injured nerves. Nerve transfer is often used to speed recovery by reconstructing the nerve closer to the nonfuctioning muscle.

More extensive surgery may be required in cases of severe nerve injuries, if the injured nerve has been untreated for a long time, or if a previous surgery on the injured nerve was unsuccessful. In those cases, the goal of surgery is to restore function to critical muscles by treatments such as transferring tendons from one muscle to another.

Rehabilitation

Rehabilitation is important for good recovery. As injured nerves heal, the muscles controlled by those nerves must be exercised in order to return to normal function. Immobility can lead to further defects, such as stiffness. Rehabilitation may involve one or more of these treatments:

• Braces or splints
  These devices help to hold the affected limb, such as the fingers, hand or foot, in the proper position in order to improve muscle function.

• Electrical stimulator
  An electrical stimulator may be used to stimulate the muscle served by an injured nerve while the nerve regrows.

• Physical and occupational therapy
  Specific movements or exercises will keep affected muscles and joints active, prevent stiffness, and help to restore function and feeling.

Medication

Patients with nerve injuries experience varying levels of pain, depending on the type and severity of the nerve injury. A variety of medications can be used to control pain, including prescription pain medications or over-the-counter medicines like aspirin or ibuprofin.

Mayo Clinic provides monitoring and follow-up care, and coordinates care with the patient's primary care or local physician.