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nerve injury and treatment of nerve injury is-
Considering injection nerve injuries are relatively rare, evidence based guidelines are not available to direct treatment. In the literature there is some disagreement regarding the timing and indication for nerve exploration in these patients. Some experts advocate an immediate exploration to wash away any irritating substance from in or around the nerve, and to perform both and internal and external neurolysis, determined by the location of the injection. Other authors suggest close follow-up with serial examinations and electrodiagnostic testing, with a consideration of surgical exploration at approximately three months if no recovery has occurred. For delayed explorations, intraoperative nerve action potentials are performed and the damaged nerve is resected and grafted if there is no action potential ellicited. Alternatively, a nerve transfer can be performed instead of nerve grafting (e.g., a triceps branch to the axillary nerve distal to the injury). For chronic (>1 year) palsies, tendon transfers may be helpful, including a posterior tibialis tendon transfer for
foot drop. As with most nerve injuries, continued physical and
occupational therapy with
bracing, as required, remains the mainstay of treatment.
Outcome
Anecdotally, injection injuries that do not spontaneously resolve in 1-2 months (i.e., neuropraxias) have a poor prognosis if untreated. If the peroneal nerve is involved, the prognosis often remains poor regardless of surgical repair, considering how proximal the injury is. Axillary nerve injuries have a better prognosis, not only because other uninvolved muscles may help partially replace the function of the deltoid, but more so because an axillary nerve injury and/or nerve repair occurs close to the denervated muscle, which often leads to robust and early reinnervation.