Functional Recovery from peripheral nerve injury

For a peripheral nerve to succesfully regenerate, four criteria must be met. Survival
of the cell body, absence of barriers, such as scar or bone that would prevent axonal
surrounding, accurate growth toward appropriate end rgans, and accomodation of
the central nervous system to reorganize mixed afferent signals. In addition,
functional recovery from peripheral nerve injury may be affected by the age and
cognitive capacity of the patient, the circumstances or nature of the nerve injury
and the subsequent repair.
Children tend to have better functional outcomes from peripheral nerve injury than
adults. Proposed reasons for this include that the nerve has less distance to cover to
reach their end organ and that children have more cerebral plasticity and better
nerve regeneration. The latter theory, however is controversial with studies showing
both better and similar nerve regeneration in adults and children. Whether age
affects recovery from nerve injury beyond childhood is also controversial. One study
found no difference in the improvement from carpal tunnel surgery between elderly
patients and younger aults. However, another study with 84 subjects who undervent
carpal tunnel release found that patients over the age 60 fared less well than those
between 31 and 59 years of age, with worse symptoms (P=0,003), power functional
outcomes (p=0.046) and less improvement in nerve conduction study findings
(p=0.027).
Patient with traumatic peripheral neuropathies have worse outcome than patients
with peripheral neuropathies from nontraumatic causes. Funtional outcomes after
crush injuries are better than those after transection followed by repair or nerve
grafting. Nerves repair sooner fare better, with less cell death, than those repaired
later. Generally, the more proximal a nerve injury is the poorer the outome because
the length of nerve that needs to regrow for reinnervation.
Examination
Patient History
Information obtained from the medical record and patient interview includes the
patients name, gender, race/ethnicity, and primary language. Gender appears to
be risk factor for certain peripheral nerve injuries. For example, carpal tunnel
syndrome seems to be more common in woman, whereas cubital tunnel syndrome
affects more men. In the presence of OBPP, a developmental and birth history
should be obtained.
Specific aspect of the patient history to be emphasized for patients with peripheral
nerve pathology include employment status and sports activities. Since entrapment
mononeuropathy may be caused by specific activities, the clinician should ask the
patient about the nature of their activities at work, school, and home. Particular
attention sould be paid to repetitive activities and positions or activities where
compression may be placed on a nerve by an external object. For exampkem
suprascapular nerve entrapment has been reported to occur in newsreel
cameramen as a result of compression of the nerve by the weight of the camera on
the shoulder