Traumatic peripheral nerve injuries are frequently evaluated by Dr. Hennessey and Dr. Kozakiewicz. A detailed neurologic clinical history, physical examination and electrodiagnostic evaluation (EMG/NCS) permits the doctors to provide an accurate diagnosis, treatment and prognosis. Both physicians have electrodiagnostic training under the guidance of past presidents of the Academy of Electrodiagnostic Medicine. Both physicians are also published in electrodiagnostic medicine. This enables Dr. Hennessey and Dr. Kozakiewicz to provide accurate information to all parties involved in any case including the patient, the referring physician, attorneys and insurance companies.
Traumatic nerve injuries can come in the common form of cervical or lumbar radiculopathies, cumulative trauma injuries, such as carpal tunnel syndrome, and more devastating peripheral nerve injuries to the radial nerve, sciatic nerve or peroneal nerve. Such traumatic nerve injuries can result in permanent pain, numbness, weakness and paralysis. Permanent traumatic peripheral nerve injuries may require custom bracing. The proper orthotic (bracing) prescription is also a medical area of expertise of Dr. Hennessey and Dr. Kozakiewicz.
There are three major types of traumatic nerve injuries.
First, there is an electrophysiologic phenomenon known as conduction slowing. This means that part of the insulation (medically termed myelin) has been adversely affected. The nerve fibers themselves are not adversely affected. With proper treatment and time, peripheral nerves can re-insulate (re-myelinate) within a two week to three month time frame. The symptoms of a conduction slowing-type of peripheral nerve injury include a sensory disturbance such as numbness, tingling or burning sensation.
Second, conduction block is another type of traumatic nerve injury. This is also medically termed neurapraxia. This means that an injured segment of a peripheral nerve has lost off of its insulin (myelin). This results in a short circuiting of the nerve that can cause all of the symptoms of a conduction block but in addition to such sensory disturbances, weakness and paralysis also occur. If there is a “good” type of weakness – this is it. Again, with proper treatment and time, over two weeks to three months the traumatically-injured peripheral nerve can re-myelinate and regain normal function.
The last type of peripheral nerve injury involves axonal death. Axon is the term for the nerve fiber itself. If the nerve fibers are damaged, this type of traumatic peripheral injury is more serious. Axonal damage to sensory fibers causes numbness and tingling. Axonal damage to motor nerve fibers can cause weakness and paralysis. Once axonal damage is involved, often the outcome results in some degree of permanent traumatic peripheral nerve injury.
With their expertise in traumatic and peripheral nerve injuries, Dr. Hennessey and Dr. Kozakiewicz are able to provide proper treatment recommendations and implement them including making the proper medical decision for exercise, activity restriction, custom bracing and the necessity and timing of surgical intervention.
Middle. Ulnar response with the same technique except with stimulation below the elbow.
Bottom. Ulnar response with the same technique except with stimulation above the elbow. Note how small this response is in comparison to the other two.
This electrophysiologic phenomenon is known as neurapraxia (also called conduction block). In this scenario, the insulation around the nerve is lost causing a “short circuit” and only part of the ulnar nerve impulse makes it to the hand. This causes numbness, tingling and weakness in an ulnar nerve distribution.
Such objective medical evidence of a nerve injury helps guide treatment and prognosis.