Nerve Conditions
Nerve injuries
Nerves can be injured following trauma to the limb - either direct laceration, stretch or pressure from bleeding or a direct force.
​
There are different degrees of nerve injuries, from bruising or stretching (often called neuropraxia), to partial damage (axonotmesis) and full damage where the nerve ends are not continuous (neurotmesis).
​
The management of the injured nerve depends on a number of factors, such as the type of injury, time since injury, type of nerve, as well as patient factors - such as age, and smoking status, for example.
​
Nerve surgery can be an option in some cases. This can involved removing scar tissue from around or within the nerve (neurolysis). Nerve transposition (moving the scarred nerve away from the sensitised skin to another location, eg under muscle or into bone) can be an option in cases with heightened pain on light tough of the skin following nerve damage).
​
Nerves can be directly repaired in the acute setting - days or a couple of weeks following injury. In long-standing injuries then nerve grafting (replacing the damaged part of the nerve with another expendable nerve), or nerve transfer (transferring an expendable nerve to 'recharge' the damaged nerve may be an option.
Spasticity
Nerve injury can lead to contracted muscle units. This can be seen in patients who have sustained head trauma during birth - for instance in cases of cerebral palsy. It can be also seen in patients who have sustained brain injuries through accidents or medical events, such as strokes or TIAs (mini-strokes).
​
Spasticity in the early stages may recover, or can sometimes be treated with medication or injections into the muscle. In long-standing cases, surgery can have a role. The type of surgery is dependent on many factors, including the goals and functional potential of the patient. Surgery may involve muscle or tendon transfer or lengthening. Parts of nerves may need to be cut or transferred. In cases with severe joint contractures, function procedures of certain joints may be required.