Traumatic Neuropathies: Spectrum of Imaging Findings and Postoperative Assessment

Abstract

Traumatic injury to peripheral nerves is a significant cause of morbidity and disability. Until reinnervation occurs, electrodiagnostic studies cannot differentiate severe axonotmetic lesions (Sunderland class 4) from complete nerve transection or neurotmesis (Sunderland class 5). This limitation is relevant clinically because in cases of neurotmesis an improved outcome may be achieved with an early surgical repair (within 1 week after trauma). High-resolution ultrasound (US) is an efficient modality to visualize injured nerves and is becoming increasingly important among radiologists and surgeons. Magnetic resonance (MR) imaging is complementary to high-resolution US, especially in evaluating deep-seated and proximal nerve segments. This article describes the imaging features of traumatic peripheral nerve lesions. The role of diagnostic imaging in stretching injuries, contusion trauma, penetrating wounds, and after surgery is discussed. A multimodality diagnostic approach including physical examination, electrophysiology, and US and MR imaging allows an accurate evaluation of most peripheral nerves. Imaging assessment of peripheral nerves trauma is useful for the diagnosis, follow-up, and postoperative evaluation.

Brachial plexus MR imaging: accuracy and reproducibility of DTI-derived measurements and fibre tractography at 3.0-T

“…Concerning traumatic neuropathies we believe that the major role of DTI may be related to type I and II Sunderland lesions where the supporting structures (including endoneurium) are intact [27]. These lesions are often diagnosed retrospectively with a poor recovery; therefore, it will be of clinical value to detect changes of FA and ADC into an intact nerve.…”

Physical medicine after limb transplantation. Therapeutic effects of physical procedures in the treatment of limb transplantation after cut-off by a threshing machine – Case report

“…However, the limb transplantation is not the end a long process of rehabilitation, it is only the beginning. The possibility of restoring limb functions after transplantation or replantation through physiotherapeutic procedures ranks among the biggest achievements of 20 th century traumatology [5]. Only complex treatment gives the possibility of restoring optimal functions of damaged nerves [10].…”

“…As is known, the upper limbs are extremely important for humans, due to the various functions they perform. Upper limb traumas may affect only the soft tissues, or may be much more serious, and may lead to fractures of hand bones, crushing by heavy objects falling on them, as well as crushing caused by the pulling of the extremity into farming equipment [4,5].…”

Hand Injuries in Children

“…Advances in imaging with high defi nition ultrasound and MRI allow an assessment of the a b peripheral nerve [ 68 ], and nerve conduction studies can be used to document the extent of nerve injury and reinnervation [ 69 ]. However, clinical assessment remains the most important tool in the management of peripheral nerve injury.…”