![]() Patient-oriented evidence in systematic review, expert opinion, randomized controlled trial, case series, Cochrane review In the absence of traumatic injury, initial treatment of nerve injuries should be conservative and include patient education, physical therapy, and activity modification. 47, 48ĭisease-oriented evidence, expert opinion ![]() Ultrasonography and magnetic resonance imaging should be used for diagnosing anatomic causes of nerve entrapment. 26, 43Įxpert opinion and clinical practice guidelineĮlectrodiagnostic testing should be used as an adjunct to physical examination and imaging to help confirm the diagnosis of peripheral nerve injury, establish the severity of injury, and monitor progression of nerve damage. Physical examination findings should be used in combination with electrodiagnostic studies to increase the accuracy of a carpal tunnel syndrome diagnosis before surgical intervention. Initial treatment is conservative, with surgical options available for refractory injuries or entrapment caused by anatomic abnormality. A detailed history and physical examination alone are often enough to identify the injury or entrapment advanced diagnostic testing with magnetic resonance imaging, ultrasonography, or electrodiagnostic studies can help confirm the clinical diagnosis and is indicated if conservative management is ineffective. ![]() Patients with nerve injury typically present with pain, weakness, and paresthesia. In the upper extremity, the brachial plexus branches into five peripheral nerves, three of which are commonly entrapped at the shoulder, elbow, and wrist. Most nerve injuries seen by family physicians will involve neurapraxia, resulting from entrapment along the anatomic course of the nerve. The extent of the injury can range from mild neurapraxia, in which the nerve experiences mild ischemia caused by compression, to severe neurotmesis, in which the nerve has full-thickness damage and full recovery may not occur. Injury can result from trauma, anatomic abnormalities, systemic disease, and entrapment. Peripheral nerves in the upper extremities are at risk of injury and entrapment because of their superficial nature and length.
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