Nerve injuries March 2018 | by EMauthor •Always suspect nerve injury in lacerations. Always test for this and document your findings. •In practice nerve injuries are most often seen in the hands and at the wrist. A good knowledge of the anatomy is helpful in drawing your attention to the possibility. Digital nerves can be repaired up to the distal inter-phalangeal joint. Beyond this there is no identifiable single nerve but a leash of fibers. •Loss of sensation may take an hour or two to develop fully. It may develop distally from the point of injury very much like that seen with a local anaesthetic block. Within half an hour of an accident de-nervated areas will have ceased to sweat and the skin will be dry. When the plastic shaft of a pen is drawn over the affected area it will slide easily. In normally innervated skin the pen will drag due to skin moisture. •It is also important to test the motor branches of potentially affected nerves and document your findings. Features of nerve injuries •Median nerve oDecreased sensation over palm and radial 3 ½ fingers oUnable to abduct thumb against resistance •Ulnar nerve oDecreased sensation over Palmar and dorsal aspects of ulnar 1 ½ fingers oLittle finger held flexed oUnable to cross index and middle fingers •Radial nerve oDecreased sensation over 1st web space •Digital nerve oDecreased sensation over ulnar or radial half digit distally Management •All injuries to nerves at the wrist should be referred to plastic surgeons •All digital nerve injury should be referred to the plastic surgery unit •In cases of suspicion, seek senior advice, discuss with the plastic surgery unit or ask the patient to come next day for re-assessment Key point: patients who are intoxicated or who have taken drugs and have sustained wounds which can lead to nerve injuries should be re-examined when sober as sometimes nerve injuries are only detectable at that stage. |
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