Interpreting Electrodiagnostic Studies for the Management of Nerve Injury

      Nerve injuries are common after trauma and can be life-altering for patients. Electrodiagnostic studies are the gold standard for diagnosing and prognosticating nerve injuries. However, most surgeons are not trained in the interpretation of these studies; rather, they rely on the interpretation provided by the electrodiagnostician, who in turn is unlikely to be trained in nerve reconstruction. This discrepancy between the interpretation of these studies and the management of nerve injuries can lead to suboptimal surgical planning and patient outcomes. This review aims to provide a framework for surgeons to take a more active role in collaborating with their colleagues in electrodiagnostic medicine in the interpretation of these studies, with an ultimate goal of improved patient care. The basics of nerve conduction studies, electromyography, and relevant terminology are reviewed. The relationship between the concepts of demyelination, axon loss, Wallerian degeneration, nerve regeneration, collateral sprouting, and clinical function are explained within the framework of the Seddon and Sunderland nerve injury classification system. The natural evolution of each degree of nerve injury over time is illustrated, and management strategies are suggested.

      Key words

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Journal of Hand Surgery
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Campbell W.W.
        Essentials of Electrodiagnostic Medicine.
        1st ed. Demos Medical Publishing, 2013
        • Ginsberg M.R.
        • Morren J.A.
        • Levin K.
        Using and interpreting electrodiagnostic tests.
        Cleve Clin J Med. 2020; 87: 671-682
        • Tavee J.
        Nerve conduction studies: basic concepts.
        Handb Clin Neurol. 2019; 160: 217-224
        • Krarup C.
        Pitfalls in electrodiagnosis.
        J Neurol. 1999; 246: 1115-1126
        • Rubin D.I.
        Needle electromyography: basic concepts.
        Handb Clin Neurol. 2019; 160: 243-256
        • Rubin D.I.
        Normal and abnormal spontaneous activity.
        Handb Clin Neurol. 2019; 160: 257-279
        • Robinson L.R.
        Predicting recovery from peripheral nerve trauma.
        Phys Med Rehabil Clin N Am. 2018; 29: 721-733
        • Mills K.R.
        The basics of electromyography.
        J Neurol Neurosurg Psychiatry. 2005; 76: ii32-ii35
        • Gordon T.
        • Yang J.F.
        • Ayer K.
        • Stein R.B.
        • Tyreman N.
        Recovery potential of muscle after partial denervation: a comparison between rats and humans.
        Brain Res Bull. 1993; 30: 477-482
        • Borenstein S.
        • Desmedt J.E.
        Range of variations in motor unit potentials during reinnervation after traumatic nerve lesions in humans.
        Ann Neurol. 1980; 8: 460-467
        • Mackinnon S.E.
        Pathophysiology of nerve compression.
        Hand Clin. 2002; 18: 231-241
        • Franssen H.
        Physiology of myelinated nerve conduction and pathophysiology of demyelination.
        Adv Exp Med Biol. 2019; 1190: 85-106
        • Wilbourn A.J.
        Nerve conduction studies. Types, components, abnormalities, and value in localization.
        Neurol Clin. 2002; 20 (v): 305-338
        • Menorca R.M.G.
        • Fussell T.S.
        • Elfar J.C.
        Nerve physiology: mechanisms of injury and recovery.
        Hand Clin. 2013; 29: 317-330
        • Seddon H.J.
        Three types of nerve injury.
        Brain. 1943; 66: 237-288
        • Sunderland S.
        Nerves and Nerve Injuries.
        1st ed. Williams & Wilkins Co., 1968
        • Mackinnon S.E.
        Nerve Surgery.
        1st ed. 2015 (Thieme)
        • Zieske L.
        • Ebersole G.C.
        • Davidge K.
        • Fox I.
        • Mackinnon S.E.
        Revision carpal tunnel surgery: a 10-year review of intraoperative findings and outcomes.
        J Hand Surg Am. 2013; 38: 1530-1539
        • Mackinnon S.E.
        Double and multiple “crush” syndromes. Double and multiple entrapment neuropathies.
        Hand Clin. 1992; 8: 369-390
        • von Guionneau N.
        • Sarhane K.A.
        • Brandacher G.
        • Hettiaratchy S.
        • Belzberg A.J.
        • Tuffaha S.
        Mechanisms and outcomes of the supercharged end-to-side nerve transfer: a review of preclinical and clinical studies.
        J Neurosurg. 2020; 134: 1590-1598

      Linked Article