Version May 2024
The general principles for managing lower extremity and upper extremity nerve injury are similar; however, tendon transfers are not commonly used as part of the reconstructive algorithm in the lower extremity.
This algorithm is intended for use in conjunction with additional UpToDate content on peripheral nerve injury.EMG: electromyography; NCS: nerve conduction studies; NMJ: neuromuscular junction.
* Suspicion based on mechanism of injury, patient history, and physical examination. Imaging studies may be needed to differentiate motor deficits caused by tendon rupture and paralysis caused by nerve injury.
¶ Six months is not absolute; the timeframe for denervation of the NMJ is variable ranging from 6 to 12 months.
Δ NCS/EMG is usually performed no sooner than 4 weeks after injury, at which time muscle fibrillation indicating denervation can be detected. Signs of nerve recovery include polyphasic potential caused by nerve sprouting and increases in waveform amplitude over time.
◊ Tendon transfer may be an option for patients with a prolonged injury duration and anticipated denervation at NMJ, when nerve transfer is not an option (eg, brachial plexus avulsion injury), or when nerve intervention does not bring about recovery.
§ For some patients, concomitant injuries (head, chest, abdomen) or wound complications (eg, acute infection, skin necrosis) may preclude timely nerve repair, or any form of reconstruction.آیا می خواهید مدیلیب را به صفحه اصلی خود اضافه کنید؟
