Nerve injury not only affects a person’s ability to move but it can also affect a person’s ability to feel, smile, and can result in excruciating pain that no amount of pain medication will alleviate. It can be frustrating not having a clear medical answer or solutions that can explain your symptoms and nerve injury.
Nerve Pain
Los Angeles
Peripheral Nerve Injuries
When a person is facing a major peripheral nerve injury, there are few resources where they can find clear and concise information on their injury and possible treatments to aid in relieving nerve pain in Los Angeles. At The Nerve Institute, we aim to educate the public on a very complex subject such as nerve injury. Dr. Goldberg believes as in most illnesses and especially for nerve injury, a patient knows the symptoms but cannot correlate the symptoms to what is happening at the biological level. Gaining a basic knowledge of the biology of nerve injury and its regeneration will allow a patient to better understand their symptoms and can ultimately participate with the treating surgeon and therapist in his/her treatment and therapy. Dr. Goldberg hopes that her website and The Nerve Institute can offer you more information on peripheral nerve injury and the latest advance in its treatments.
What are peripheral nerves?
Peripheral nerves are delicate specialized organs that carry messages back and forth from the brain and spinal cord to the rest of the body. Nerves help do things such as sense that the feet are cold or hot, control muscle movement, and regulate breathing as well as regulating the digestive system. In a sense, peripheral nerves are the electrical circuit of the human body, when those are injured it can cause nerve pain in Los Angeles. Therefore, one can envision a nerve as a coaxial cable that is made up of fibers called axons and insulated by surrounding connective tissues. The major nerves directly coming out of the spinal cord are composed of both sensory (provide sensory information) and motor (control muscle contraction) axons. As the major nerves travel closer to the legs or arms, the axons divide, and the nerves become either purely motor or sensory.
How is the severity of nerve injury graded?
The Severity of a nerve injury is based on a scale of 1 to 6 called the Sunderland’s classification of nerve injury. Degree 1 is the least severe and 5 is the most severe.
Degree I (Neuropraxia) is when the nerve is bruised but the nerve axon itself remains intact. Therefore, the nerve function should return to its full function spontaneously without any surgical intervention. Full recovery is expected at 3 months from the time of injury.
Degree II (Axonotmesis) – during nerve pain in Los Angeles the axon is injured but the content of the axon remains intact. Full spontaneous recovery is expected. However, the nerve regenerates at a rate of 1 mm/day from the site of injury to the expected target muscle or sensory organ. For example, if the axon was slightly crushed but remains intact along the nerve at the elbow level. The innervation of target muscle within the hand.
Degree III (grade 2 + Endoneural injury) – The axon and its innermost connective tissue covering, the endoneurium, is injured. Surgical intervention is likely required for nerve recovery.
Degree IV (grade 3 + Perineural injury) – the axons are injured along with perineurium injury. Surgical intervention is required for nerve recovery.
Degree V (grade 4 + endoneural injury) – complete laceration of a major peripheral nerve and surgical intervention is required for nerve recovery.
Degree VI – The 6th degree of nerve injury is also known as neuroma in continuity which is a combination of 1st through 5th degree of fascicular injury within a major peripheral nerve. This type of nerve pain in Los Angeles consists of an injury whereby the nerve is crushed or stretched or partially cut.
What is the basic anatomy of a nerve?
Nerve fibers, either sensory or motor axons, aggregate into a fascicle group which is encased by a layer of connective tissue called the perineurium. The perineurium is responsible for maintaining the physiologic milieu (nutritional elements) which enables electrical conduction allowing the nerves to carry information from the brain and spinal cord to the target organs. Breaching this perineurium interferes with nerve conduction and provokes demyelination (injury) of underlying nerve fibers. A thicker connective layer calls the epineurium covers the entire nerve. Live within the epineurium is the blood supply to the entire nerve sheath called the vasa nervorum. The Vasa Nervorum carries blood supply to the nerve and the epineurium allows the nerve to glide without tension or traction across a joint.
How does a peripheral nerve get injured?
Peripheral nerves are fragile and easily damaged. A nerve injury can affect the brain’s ability to communicate with muscles and organs. Damage to the peripheral nerves is called peripheral neuropathy.
Peripheral nerves can be damaged in several ways, causing Nerve pain in Los Angeles:
- Injury from an accident, a fall, or sports, which can stretch, compress, crush, or cut nerves
- Medical conditions, such as diabetes, Guillain-Barre syndrome, and compression neuropathy due to repetitive movement such as carpal tunnel syndrome
- Autoimmune diseases include lupus, rheumatoid arthritis, and Sjogren’s syndrome.
Other causes include narrowing of the arteries, hormonal imbalances, and tumors.
Most peripheral nerve neuropathy is due to the reasons listed in #1.
What happens to a nerve when it is injured?
When an axon is cut, the proximal and distal cut ends undergo a cellular death process known as Wallerian Degeneration. In the distal cut nerve end, Schwann cells (specialized cells that provide insulation for the axon and allow faster electrical conduction) clear the dead cellular debris and lay down a new scaffold to receive new proximal axon regeneration.
In the proximal axon, the same cellular death occurs with the clearing of cellular debris and the axon degenerates back to the level of the intact node of Ranvier. New axonal sprouting will occur also known as a nerve cone starting a process known as axonal regeneration. In axonometric (2nd-degree nerve injury), the intact endoneurial lining will guide these regenerating sprouting nerve cones to their target end organs bringing relief to nerve pain in Los Angeles.
In Neuromesis (Degree III through V), the endoneurial lining is injured and thus these growth cones do not have a guided path back to their target organ and thus it will form a neuroma. A neuroma can be considered as a live cut electric wire that can sparks which causes significant pain at the site of injury.
Axon regenerates at a rate of 1 to 3mm/day. Axons carry motor signals from the brain and spinal cord to the muscle and control muscle movement. The motor end plates (MEP) are specialized interfaces between the axon and the skeletal muscle.
The MEP in the muscle starts to degenerate once a nerve is injured due to the interruption of an electrical signal. The MEP degrades at a rate of approximately 1 %/week. Irreversible MEP degrades 24 months after the neurological circuit is interrupted.
Sensory end organs, the equivalent of MEP for sensation, remain viable much longer and thus can retain the potential for re-innervation for a much longer period.
Due to the slow rate of axonal regeneration (1mm/day) and the faster rate of MEP degeneration, early diagnosis, and prompt treatment is crucial in peripheral nerve injury.
