Electrodiagnostic Assessment of Peri-Procedural Iatrogenic Peripheral Nerve Injuries and Rehabilitation.

Abstract

Iatrogenic nerve injuries are a significant concern for medical professionals and the patients affected. Peri-procedural nerve injuries result in functional deficits associated with pain and disability. The exact pathophysiology and etiology of peri-procedural nerve injuries are complex and often elude providers. The rates of injury to specific nerves are unclear and relate to both procedural and patient specific risk factors. Initial classification of the nerve injury into neurapraxia, axonotmesis, mixed nerve injury, or possible complete transection (neurotmesis) guides rehabilitation and management. Electrodiagnostic medical consultation at least four weeks post-injury, supplemented with nerve imaging (ultrasound and magnetic resonance imaging), can allow for accurate nerve injury classification. Supplemented with nerve imaging and detailed clinical evaluation, treatment, recovery and rehabilitation can be maximized. Recognizing nerves at risk associated with medical and surgical procedures can facilitate injury avoidance and early diagnosis. If a nerve injury is incomplete, in an optimized physiologic milieu (good glucose control, smoking cessation, etc.), there is a good potential for spontaneous (total or partial) improvement over time. Surgical referral should be considered for severe nerve injuries within 6 months, especially if there is concern for neurotmesis, and/or deteriorating nerve function. This review gives guidance for approaching peri-procedural peripheral nerve injuries, including the timing and the role of electrodiagnostic medical consultation including serial electrodiagnostic studies in management and rehabilitation.