Leeds Institute for Medical Research, University of Leeds, Leeds, UK.
Department of Plastic and Reconstructive Surgery, Leeds Teaching Hospitals Trust, Leeds, UK.
J Hand Surg Eur Vol. 2024 Jun;49(6):668-680. doi: 10.1177/17531934241238736. Epub 2024 Mar 27.
Predicting prognosis after nerve injury and compression can be challenging, even for the experienced clinician. Although thorough clinical assessment can aid diagnosis, we cannot always be precise about long-term functional recovery of either motor or sensory nerves. To evaluate the severity of nerve injury, surgical exploration remains the gold standard, particularly after iatrogenic injury and major nerve injury from trauma, such as brachial plexus injury. Recently, advances in imaging techniques (ultrasound, magnetic resonance imaging [MRI] and MR neurography) along with multimodality assessment, including electrodiagnostic testing, have allowed us to have a better preoperative understanding of nerve continuity and prediction of nerve health and possible recovery. This article outlines the current and potential roles for clinical assessment, exploratory surgery, electrodiagnostic testing ultrasound and MRI in entrapment neuropathies, inflammatory neuritis and trauma. Emphasis is placed on those modalities that are improving in diagnostic accuracy of nerve assessment before any surgical intervention.
预测神经损伤和压迫的预后可能具有挑战性，即使对于经验丰富的临床医生也是如此。虽然全面的临床评估有助于诊断，但我们不能总是准确地预测运动或感觉神经的长期功能恢复。为了评估神经损伤的严重程度，手术探查仍然是金标准，特别是在医源性损伤和创伤引起的主要神经损伤（如臂丛损伤）后。最近，影像学技术（超声、磁共振成像[MRI]和 MR 神经成像）的进步以及包括电诊断测试在内的多模态评估，使我们能够更好地术前了解神经连续性，并预测神经健康和可能的恢复情况。本文概述了临床评估、探查性手术、电诊断测试、超声和 MRI 在压迫性神经病、炎症性神经炎和创伤中的当前和潜在作用。重点放在那些在任何手术干预之前提高神经评估诊断准确性的方法上。
