Nerve Injury

November 7, 2018

It is difficult to understand how a numb area of the body can be painful, however, this is common with a nerve injury.

 

 

 

The nerves are the electrical wiring system in our body. Nerves carry feeling or sensation from the skin to the brain, and also carry the signal to move from our brain to the muscles. When a nerve is injured, a person can have weakness or paralysis in that body part. There can be numbness, “pins and needles” sensations, tingling, and or pain. It is difficult to understand how a numb area of the body can be painful, however this is common with a nerve injury.

 

Whenever a nerve is injured a number of questions arise. Will this nerve injury recover? Will the recovery be complete or partial? How long will it take?  What can I do to help? What can doctors do to help?

 

The nerves in our body fall into two categories:

 

The central nervous system which includes the brain and spinal cord. Injury to this area of the nervous system is permanent. 

 

The peripheral nervous system which includes the nerves in the arms and legs. These nerves have the capacity to recover from injury. 

 

Nerve injuries fall into several categories

 

In layman’s terms, a nerve can be compressed, bruised, partially damaged, or completely cut. 

 

A compressed nerve, such as carpal tunnel compression of the median nerve at the wrist can be surgically decompressed to take the pressure off the nerve. 

 

A bruised nerve typically recovers quickly and completely. 

 

A partially damaged nerve can recover by two methods

 

A nerve is similar to a large electric cable; there are a number of “wires” on the inside called axons with an outer sheath around the nerve. If an axon inside the nerve is severely damaged, the end of that axon will die. This axon will need to regrow in order to recover. If some of the axons survived and go past the site of the injury, they will send out branches to reach the muscle that does not have its nerve supply. This type of recovery is called collateral sprouting. Both of these types of recovery take significant time to occur. This recovery is up to mother nature. How much a nerve will or will not recover is impossible to determine.

 

Nerve Surgery

 

Nerve surgery is done if a nerve is completely cut in half. A nerve that is cut will try to regrow, but when the outer sheath is destroyed, the nerve cannot make it to the correct destination, and will often grow into a ball called a neuroma.  A clean laceration of a nerve with no tension will be surgically reconnected. If the nerve injury is more extensive, then nerve graft surgery may be performed. In nerve graft surgery a nerve from elsewhere in the body is sacrificed, commonly the side of the ankle. This leaves a permanent numb patch. The outer sheath is used to make a bridge, or a path, for the nerve to regrow. This nerve growth is very slow, about a half to one inch per month.

 

Recommendations:

 

  1. Medications are available for nerve pain. These include Neurontin (gabapentin), Lyrica (pregabalin), or Cymbalta (duloxetine). These medications may help nerve pain, however, they do not fix a nerve injury. The medications will not correct numbness. They will not speed up the recovery of the nerve injury. 

  2. I recommend laboratory tests to evaluate for underlying health issues which can impair nerve recovery - a hemoglobin A-1 C to rule out diabetes or pre-diabetes, thyroid studies, and a vitamin B12 blood test with the goal being between 400 to 1,000.  

  3. Avoid excess vitamin B6. Doses of vitamin B6 greater than 100 mg are toxic to nerves and actually cause nerve damage.

  4. Healthy living and avoiding excess alcohol is important, as alcohol is toxic to the nerves.

  5. Maintaining range of motion in the body part affected by the nerve injury is critical. If a joint becomes stiff, even if the nerve regrows to the muscle, the function will not be normal. Stretching the body part that has a nerve injury, several times a day, is very important.

  6. It is unknown if alternative treatments such as stem cell injections are of benefit.

 

Nerve injuries can be devastating. How much the nerve recovers is up to Mother Nature. This is terribly difficult and frustrating for both patient and doctor. 

Most recovery will plateau at two years. 

 

To schedule an appointment with Dr. Katharine Leppard, please call her office at 719-575-1800.

 

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