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The patient had neuropraxia, which manifested as loss of sensation and motor function in the right upper limb immediately after recovery from general anesthesia.
After 4 weeks of management, the patient had recovered significantly from his neuropraxia and was able to pull, eat and write with the right hand; normal sensation had also been restored to the 'anaesthetized' areas.
In comparison to the blind needle insertion required using surface landmark techniques (4), ultrasound guidance may improve accuracy of needle placement, and potentially reduce the incidence of neuropraxia arising from trauma to nerves (2,3).
Nitz et al (1985) found a high incidence of peroneal nerve and posterior tibial neuropraxia in grade III ankle sprains and that 17 percent of grade II and 86 percent of grade III sprains had moderate denervation in the muscles supplied by the peroneal nerve.
When performed as part of follow-up, newer MRI techniques may allow for differentiation between neuropraxia, axonotmesis, and neurotmesis.
Table 1 Nerve Injury Classifications Prognosis for Sunderland Spontaneous Seddon Grade Grade Structures Injured Recovery Neuropraxia 1 Myelin Full Axonotmesis 2 Myelin, Axons Functional 3 Myelin, Axons, Endoneurium Incomplete 4 Myelin, Axons, Endoneurium, None Perineurium Neurotmesis 5 Myelin, Axons, Endoneurium, None Perineurium, Epineurium Table 2 MRC Grades of Muscle Strength Grade Motor Function 0 No movement or contraction 1 Trace movement or fasciculations 2 Active motion with gravity eliminated 3 Active motion against gravity only 4 Active motion against some resistance 5 Full strength Table 3 Summary of Incidences of Lower Extremity Nerve Injuries Traumatic Iatrogenic Femoral Nerve Acetabulum THA overall: 0.
However, on further examination by a neurologist, the neurological deficit was attributed to ulnar nerve neuropraxia, probably secondary to nerve compression.
The neuropraxia has resolved upon follow-up examination.
Neuropraxia (Sunderland Type 1) is described as an injury to the myelin sheath only.
Current recommendations for this suspected lesion is to wait 8 to 10 weeks for neuropraxia to resolve.
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