Whenever anyone meets with an accident, the first suspicion is a fracture because that may be the most obvious. But how many think of a nerve injury?
Nerve injuries due to accidents are common, explains Sri Lanka’s one-and-only Consultant Clinical Neurophysiologist, Dr. Sudath Gunasekera, stressing that more and more motorcyclists involved in accidents are suffering such injuries, especially those with shoulder injuries.
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| Dr. Sudath Gunasekera |
Leading us into the Neurophysiology Unit of the Institute of Neurology, National Hospital, which has the ‘nerve-testing equipment', Dr. Gunasekera simply asks a youth from Embilipitiya being tested by his junior, whether he was in a motorcycle accident.
“Yes,” is the mumbled reply by the youth. “It was a collision with a lorry.”
With everyone mandatorily having to wear crash helmets, the head is safe, explains Dr. Gunasekera, but not the shoulder. Over 90% of nerve injuries in the shoulder region in adults are due to motorcycle accidents.
“When a motorcyclist sees that he is about to hit another vehicle, he will try to swerve and in the process the brunt of the crash will be on the shoulder,” he says, underscoring the fact that safe-riding is of paramount importance.
Sometimes, Dr. Gunasekera tells MediScene, the hand is in a sling and externally there seems to be nothing major except a few cuts and bruises. But the arm is weak and it is vital to treat nerve injuries before it is too late. Nerves are the “wiring” that carries messages from the brain to the rest of the body.
Those days, MediScene understands, the more common nerve injuries were due to war wounds but now with peace in the country, such injuries caused by accidents have taken precedence.
Pointing out the different types of injuries, he says some may be due to cuts from a weapon, machinery or metal pieces; others due to projectiles such as a gunshot or shrapnel from a blast; while the third category is from severe stretching. Nerve injuries could also occur due to displacement of bones with a dislocation or fracture stretching or pressing a nearby nerve.
The nerve injury could be distal (anatomically located far from the point of attachment of the limb to the body) or proximal (next to or nearest the point of attachment), it is learnt.
Taking a shoulder injury as an example, Dr. Gunasekera explains that the brachial plexus may be affected. The brachial plexus is a network of nerves that originate from the spinal cord near the neck and shoulder fanning out to control the hand, wrist, elbow and shoulder.
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| A youth being tested with the nerve-testing
equipment.
Pic by M.A. Pushpa Kumara |
Trauma could lead to vascular injuries or injuries to blood vessels (arteries or veins), bone injuries or even soft tissue injuries. However, it is crucial to check out a nerve injury as well because it can cause severe functional impairment, especially if it is the dominant hand, MediScene understands.
The symptoms will include weakness in a portion of the limb or even the whole limb, says this Neurophysiologist, adding that there could also be numbness. Sometimes, though, the numbness may go unnoticed due to the weakness. There could also be pain.
Then the injured patient will usually be checked out first by a Surgeon who will ascertain the nature of the injury through a clinical examination and then refer to the Neurophysiology Unit for specialized investigation as a nerve injury could sometimes be difficult to identify.
The clinical neurophysiologist will then conduct a series of tests including the sophisticated nerve conduction test and needle EMG not only to determine whether there is a nerve injury but also which nerve or nerves are affected and at what level.
Is it only a part of the nerve that has been damaged or is it the whole nerve, he will find out, while correlating the findings with the mechanism of the injury, be it a cut, fracture or stretch.
“We will also find out the level and severity of the nerve injury,” he says.
These are crucial determinants, for if it is mild there will be no surgery but if it is moderate or severe, the patient may have to undergo an operation, MediScene learns.
The Neurophysiology findings will also guide the Surgeons to plan out and decide on the type of surgery.
For Dr. Gunasekera that is what is “rewarding”.
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