NERVE INJURIES

Nerves provide a pathway for impulses to be transmitted along each of the axons to the limbs and organs. Nerve tissue consists of neurons, which are excitable cells that transmit information as electrical signals, and glial cells which perform a variety of non-signaling functions such as forming myelin to provide support and insulation between neurons, phagocytizing and removing cellular debris, removing excess neurotransmitters, and forming the blood-brain barrier. Myelin sheaths increase the conduction velocity of signals across axons. The myelin sheath wraps around the fibers that are the long threadlike part of a nerve cell. The sheath protects these fibers, known as axons, a lot like the insulation around an electrical wire.

If you have multiple sclerosis (MS), a disease that causes your immune system to attack your central nervous system, your myelin sheaths can be damaged. That means your nerves won't be able to send and receive messages as they should. Because of this, MS can weaken your muscles, damage your coordination, and, in the worst cases, paralyze you.

 Classification of the nerve injury depends on the nerve components affected, loss of functionality and the ability of the nerve to recover. In 1941, Seddon introduced a classification of nerve injuries based on three main types of nerve fiber injury and whether there is continuity of the nerve. Seddon's classification includes neurapraxia, axonotmesis, and neurotmesis in the order of increasing severity.

1. NEURAPRAXIA       

Neurapraxia is the mildest form of nerve injury and the nerve remains intact. Provided the compression is mild and limited in time, such a metabolic block is reversible. With extended compression, there may be oedema within the fascicles resulting in a local conduction block lasting longer than the duration of the precipitating cause. The myelin sheath is damaged but axonal continuity is preserved. The nerve's signaling ability is impaired; however, because there is no axonal injury, this injury usually heals completely. Recovery could take up to 12 weeks.

2. AXONOTMESIS

Axonotmesis occurs in crush injuries or displaced bone fractures causing disruption of the nerve cell axon with no or only partial interruption of the connective tissue framework. This type of nerve injury necessitates the regrowth of the axon to the target muscle, which takes time. The number of disrupted axons and the extent of scar formation at the site of nerve injury determine whether patients with axonotmesis require surgical treatment.

3. NEUROTMESIS

This is the most serious nerve injury causing complete anatomical disruption of the both the axon and all of the surrounding connective tissue (rupture of the nerve). There will be no recovery, there will be fibrillation, and surgery is usually required. Typically, the motor neuron unit potential is absent. If the motor unit potential is discovered, it indicates that the axon has been spared.

CAUSES OF NEVER INJURIES

There are a variety of mechanisms that can lead to nerve compression and several factors may be present at the same time, especially at the carpal tunnel. Anything that results in trauma/compression of nerves can result in nerve pain and nerve damage.

Autoimmune diseases. Nerve pain and nerve damage symptoms can be caused by a variety of autoimmune diseases. Multiple sclerosis, Guillain-Barré syndrome (a rare condition in which the immune system attacks the peripheral nerves), lupus, and inflammatory bowel disease are examples of these. Other causes include narrowing of the hormonal imbalances, arteries and tumors

Traumatic. Any injury causing soft tissue swelling or a fracture will affect the pressure, particularly in tight compartments, such as the carpal tunnel.

Swellings. Tumors, of which ganglia are the most common, infections such as an abscess, and vascular tumors such as aneurysm or thrombosis of the median artery, can reduce space for a nerve.

Degenerative. Remodeling of a joint or collapse associated with osteo-arthritis, osteophyte formation and instability of joints may result in nerve compression.

Drug side effects and toxic substances. Various substances that are intentionally or unintentionally ingested into the body have the potential to cause nerve pain and damage. Medication falls into this category, as do some cancer chemotherapies and HIV medications. Chronic alcohol abuse is a leading cause of nerve pain and damage.

Injury from an accident, a fall or sports can stretch, compress, crush or cut nerves.

Treatment and Diagnosis

If a nerve is injured but not severed, your injury has a better chance of healing. Injury to the nerve that has been completely severed is extremely difficult to treat, and recovery may not be possible.

Your treatment will be determined by your doctor based on the extent and cause of your injury, as well as how well the nerve is healing. You may not need surgery if your nerve heals properly. It's possible that you'll need to rest the affected area until it heals. Nerves recover slowly, and full recovery may take months or years. Regular checkups will be required to ensure that your recovery remains on track. If the cause of your injury is a medical condition, your doctor will treat the underlying condition.

Your doctor may recommend physical therapy to prevent stiffness and restore function Braces or splints. These devices keep the affected limb, fingers, hand or foot in the proper position to improve muscle function.

Physiotherapy management

Physical therapy involves specific movements or exercises to keep your affected muscles and joints active. Physical therapy can prevent stiffness and help restore function and feeling. A physiotherapist will carry out a number of treatments can help restore function to the affected muscles including:

1. Electrical stimulator. Stimulators can activate muscle served by an injured nerve while the nerve regrows. However, this treatment may not be effective for everyone. Your doctor will discuss electrical stimulation with you if it's an option.

Mostly a physiotherapist will use Transcutaneous Electrical Neuromuscular Stimulation (TENS) to manage acute and chronic pain in physical therapy. Your physical therapist will use TENS to decrease your pain by applying electrodes to your body over painful areas. The intensity of the electricity will be adjusted to block the pain signals traveling from your body to your brain.

Neuromuscular electrical stimulation (NMES) uses high intensities that cause excitation of peripheral nerves to produce a muscle contraction

2. Braces or splints. A physiotherapist will use these devices to keep the affected limb, fingers, hand or foot in the proper position to improve muscle function.

3. Nerve flossing/ nerve gliding -in physical therapy this technique is used to improve the way your nerves move. Occasionally after injury or illness, muscles, joints, and tendons can become tight. Nerves can also become tight after an injury, and your physical therapist may determine that nerve flossing is necessary to help improve neurodynamics (nerve motion) and help you move better and feel better. Your therapist may prescribe nerve glides to help you fully recover.

4. Exercise. Exercise can help improve your muscle strength, maintain your range of motion and reduce muscle cramps.

Physiotherapy for nerve pain is a common treatment option that works to achieve results in reducing pain, minimizing discomfort, and optimizing mobility and flexibility. Nerve pain treatment is typically a very effective component of physiotherapy intervention.