Page 9 - Read Online

Topic: Peripheral Nerve Repair and Regeneration

Clinical neurophysiology and imaging of

nerve injuries: preoperative diagnostic

work-up and postoperative monitoring

Andrea Gagliardo , Francesca Toia , Francesco Maggì , Alessio Vincenzo Mariolo ,
2
2
1
2
Michele Cillino , Francesco Moschella 2
2
1 “Clinical Course” Neurophysiology Unit, NHS Accredited, 90146 Palermo, Italy.
2 Plastic and Reconstructive Surgery,Department of Surgical, Oncological and Oral Sciences, University of Palermo, 90127 Palermo, Italy.

Address for correspondence: Dr. Francesca Toia, Plastic and Reconstructive Surgery, Department of Surgical, Oncological and Oral Sciences,
University of Palermo, 90127 Palermo, Italy. E-mail: francescatoia@gmail.com
ABSTRACT
Peripheral nerve injuries are a heterogeneous group of lesions that may occurs secondary to
various causes. Several different classifications have been used to describe the pathophysiological
mechanisms leading to the clinical deficit, from simple and reversible compression-induced
demyelination, to complete transection of nerve axons. Neurophysiological data localize, quantify,
and qualify (demyelination vs. axonal loss) the clinical and subclinical deficits. High-resolution
ultrasound can demonstrate the morphological extent of nerve damage, fascicular echotexture
(epineurium vs. perineurium, focal alteration of the cross-section of the nerve, any neuromas, etc.),
and the surrounding tissues. High field magnetic resonance imaging provides high contrast
neurography by fat suppression sequences and shows structural connectivity through the use
of diffusion-weighted sequences. The aim of this review is to provide clinical guidelines for the
diagnosis of nerve injuries, and the rationale for instrumental evaluation in the preoperative and
postoperative periods. While history and clinical approach guide neurophysiological examination,
nerve conduction and electromyography studies provide functional information on conduction
slowing and denervation to assist in monitoring the onset of re-innervation. High-resolution nerve
imaging complements neurophysiological data and allows direct visualization of the nerve injury
while providing insight into its cause and facilitating surgical treatment planning. Indications and
limits of each instrumental examination are discussed.

Key words:
Electromyography, imaging, injury, magnetic resonance imaging, nerve conduction studies,
neurodiagnostic, peripheral nerve, ultrasound

INTRODUCTION adults at the peak of their employment productivity, and
therefore, functional decline associated with nerve lesions
Every year more than 5% of patients admitted to a is particularly significant. Thus, there is a great interest
[2]
level one trauma center have a concurrent traumatic in optimizing both the diagnostic accuracy and early
peripheral nerve injury. These patients are often young treatment of peripheral nerve injuries.
[1]
The purpose of this review is to discuss peripheral
Access this article online
nerve injuries and their diagnostic management and
Quick Response Code: outcomes evaluation with regard to clinical findings and
Website:
www.parjournal.net neurodiagnostic studies and imaging.
The goal is to provide a practical guide for general
DOI: management that is, applicable to all types of nerve
10.4103/2347-9264.160877 injuries. The main classifications and basic principles
of a correct clinical approach will be summarized. Next,

Plast Aesthet Res || Vol 2 || Issue 4 || Jul 15, 2015 149