Nerve injuries of the upper extremity and hand

EFORT Open Reviews

article

Lars B. Dahlin¹  Mikael Wiberg² 

[1] Department of Translational Medicine - Hand Surgery, Lund University, and Skåne University Hospital, Sweden. Department of Translational Medicine - Hand Surgery, Lund University, and Skåne University Hospital, Sweden. Department of Translational Medicine - Hand Surgery, Lund University, and Skåne University Hospital;Department of Surgical and Perioperative Science, University Hospital, and Department of Integrative Medical Biology, Umeå University, Sweden. Department of Surgical and Perioperative Science, University Hospital, and Department of Integrative Medical Biology, Umeå University

关键词: nerve injury;    nerve repair;    nerve reconstruction;    nerve transfer;    nerve regeneration;    neuroma;   

DOI  :  10.1302/2058-5241.2.160071

学科分类：神经科学

来源: The British Editorial Society of Bone & Joint Surgery

【 摘 要 】

Injuries to the extremities and hand are common; the incidence of hand injuries is 7 to 37/1000 inhabitants/year in Europe1 and around 50% of the injuries are fractures. Among the affected structures that are much less affected (i.e. around 3%) are peripheral nerves; the incidence of nerve injury is 0.14/1000 inhabitants/year.2 Nerve injuries most commonly affect the upper extremities, but the sciatic, peroneal and tibial nerve trunks may also be affected in the lower extremities, where the regenerative capacity varies; for example, the peroneal nerve is worse than the tibial nerve.3 Treatment of peripheral nerve injuries is a real challenge for surgeons and physicians, since the outcome after different procedures still may be insufficient, although continuous efforts have been made to improve the outcome. To make a correct diagnosis and to treat patients properly with various nerve injuries and disorders, it is important to have a basic knowledge of the neurobiological mechanisms that are active after injuries, since strategies to improve the outcome following nerve injuries are often based on such mechanisms. If the patients are treated with a delay, or if the care is inappropriate, it will often reduce the functional outcome and create further costs for society due to potentially more extensive surgical procedures, longer rehabilitation and longer sick leave.4,5 Furthermore, the outcome of treatment of nerve injuries depends on a large number of different factors, but two important ones are the competence and experience of the treating surgeon as well as the quality of the staff performing the rehabilitation – a vital teamwork. In the present review, the principles for treating nerve injuries located at the finger level up to the brachial plexus level, as well as principles valid for nerve injuries in the lower extremities, are presented and related to the neurobiological alterations that occur in peripheral nerves and in the surrounding cells as well as the secondary changes occurring up in the central nervous system.

【 授权许可】

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