An Overview Of The Three Different Types Of Nerve Injury

Nerve injuries occur from all different types of medical problems. The issue can range anywhere from a gunshot injury to a blunt force trauma associated with a motor vehicle accident to compression from a tumor. It’s a good idea to have an understanding of the different ways a nerve can be injured. That way one can understand the prospects for recovery.

The first nerve injury type is referred to as a neurapraxia. During this injury the nerve maintains all of its internal anatomy. The internal connections are unaltered but the injury maintains a physiologic block to nerve conduction.

Examples of a neurapraxic injury include having a tourniquet in place to stop bleeding. This may be during surgery or in a trauma situation to prevent too much blood loss. Having the tourniquet in place for too long may cause permanent injury to the peripheral nerves in the extremity. This is why surgeons often let down the extremity tourniquet every hour or so to let blood flow come back into the region and replenish the peripheral nerves.

Another type of neurapraxic injury can be if an alcoholic blacks out and ends up with a “Saturday Night Palsy.” In a typical situation people move around a lot while sleeping. This prohibits nerves from ending up in one position for too long and getting compressed. If one becomes intoxicated and blacks out, he or she may not move around and end up sustaining a compression injury, like having an arm over a park bench with consistent compression overnight.

So long as the injury hasn’t been continuous for an extended period, there is recovery potential, maybe even complete. Out of the 3 nerve injury types, neurapraxia is usually the best chance for recovery since the structures themselves are anatomically intact.

Axonotmesis is the next category of nerve injury. This represents an anatomical disruption of the inside of the nerve structure, the axons, however, the outer external connective framework remains mostly intact.

This type of nerve injury requires significant regrowth of the axon, not just a “waking up” of the existing axon as with a neurapraxia. The axon needs to regrow along its path towards the target muscle it controls. In adults, this growth occurs at a rate of 1 inch monthly, or about 1 mm per day.

One example of an axonotmesis is a motor vehicle accident where the crush injury is more severe than a neurapraxia. The recovery possibilities remain good since the pathway exists telling the axon where to regrow.

The third type of nerve injury is the most severe and is referred to as a neurotmesis. This represents a transection of the nerve or complete disruption of the axons along with the external connective tissue framework. A knife injury would be an example where the nerve is completely severed. Early surgical intervention is recommended as spontaneous recovery is highly unlikely.

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