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Clinics in neurology and neurosurgery of sport: peripheral nerve injury
  1. G Davis1,
  2. D G Kline2,
  3. R J Spinner3,
  4. E l Zager4,
  5. M J Garberina5,
  6. G R Williams5,
  7. P McCrory6
  1. 1
    Cabrini Medical Centre, Malvern, Victoria, Australia
  2. 2
    Academic Faculty, Ochsner Clinic Foundation, New Orleans, Louisiana, USA
  3. 3
    Mayo Clinic, Department of Neurologic Surgery, Orthopaedics and Anatomy, Rochester, Minnesota USA
  4. 4
    Department of Neurosurgery, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA
  5. 5
    Department of Orthopaedic Surgery, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA
  6. 6
    Centre for Health, Exercise and Sports Medicine, University of Melbourne, Victoria, Australia
  1. Associate Professor P McCrory, Centre for Health, Exercise and Sports Medicine, University of Melbourne, Victoria, Australia 3010; p.mccrory{at}unimelb.edu.au

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Peripheral nerve injuries are not uncommon in sports. Typically, these are associated with orthopaedic injury (eg, axillary nerve injury with glenohumeral joint dislocation) rather than the transection or gunshot-type injuries often seen in emergency departments.

The classification of nerve injuries is complex,1 2 but the underlying principle is that the simplest of nerve injuries is a physiological loss only (neurapraxia) and the most severe form is complete anatomical transection of the nerve and its coverings (neurotmesis). Between these two extremes are varying degrees of injury to the axon and its covering sheath.

With all degrees of nerve injury, the greater the degree of preservation of anatomical structures, the greater the chance of neurological recovery. Thus a neurapraxic injury will recover spontaneously, whereas a neurotmetic injury will not recover without surgical intervention. Between these two ends of the spectrum is a large group of nerve injuries in which the capacity for spontaneous recovery cannot be accurately assessed clinically and may require surgical exploration with or without nerve repair.

On the sports field, the most common mechanism of nerve injury is a stretch or traction type of injury. In the first few weeks following a stretch injury, clinical observation is required. and after sufficient time has elapsed for Wallerian degeneration to occur (at least 2 weeks), then nerve conduction studies (NCS) and electromyography (EMG) can be performed. Over the following 6–8 weeks, a nerve injury is then followed by clinical examination and repeat NCS/EMG, with the objective being to determine whether spontaneous recovery will occur. If there is failure of neurological recovery at 3 months after the injury, then surgical intervention is required to facilitate recovery before irreversible fibrosis in the denervated muscle results.

The principles used by the peripheral nerve surgeon include neurolysis, intraoperative nerve action potentials (NAP), primary repair, …

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