Peripheral Nerve Injuries (MBBS India)

Polyneuropathy is any disease process affecting the function of or causing damage to multiple nerves of the peripheral nervous system. There are numerous etiologies of polyneuropathy, most of which are systemic and the most common of which is diabetic neuropathy. The clinical presentation varies by etiology as well as classification of the polyneuropathy, but generally manifests as sensorimotor disturbances (pain, paresthesia, numbness, weakness, and loss of coordination and balance), which have a gradual onset and progressive course. Distal nerves are affected most commonly, but the disease process may progress proximally with time or progression of the underlying etiologic disease entity. Diagnosis is made clinically, but laboratory studies, electrodiagnostic testing, and/or nerve biopsy may be required in some cases. Management varies depending on the etiology.

Neuropathy is a nerve pathology presenting with sensory, motor, or autonomic impairment secondary to dysfunction of the affected nerve. The peripheral nerves (outside the brain and spinal cord), are derived from several plexuses, with the brachial and lumbosacral plexuses supplying the major innervation to the extremities. Mononeuropathy (affecting a single nerve) and plexopathy (affecting the plexus) can occur from trauma, compression, and systemic diseases. The clinical presentation varies according to location, type of nerves affected, and cause of the damage. Diagnosis requires a thorough physical examination, and diagnostic tests include laboratory tests, imaging and a confirmatory nerve conduction study, and electromyography. Management depends on the etiology but centers around physical therapy, supportive care, and treatment of underlying issues.

Peripheral nerve damage affecting the upper extremities is a common occupational injury and also occurs in individuals who participate in recreational sports. Injuries can affect the axillary, musculocutaneous, median, ulnar, or radial nerves. The most common causes of these injuries are overuse, compression or entrapment, or nerve trauma; degenerative or demyelinating disorders; radiation therapy; and mass lesions. Clinical presentation is with motor and/or sensory deficits. Diagnosis is made clinically and based on electrodiagnostic and imaging studies. Treatment in most cases is conservative, although surgical intervention may occasionally be necessary.