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Evaluation and Management

Evaluation and management of the peripheral nerve injury patient is a challenge to the treating surgeon.
• The diagnosis may be difficult to make--is it an injury at the root level/cord level/peripheral level?
• Restraint and patience can be critical--some patients with global peripheral nerve dysfunction due to a gunshot wound injury can fully recover without surgical intervention (in fact, premature intervention may do more harm than good).
• The management options when surgery is indicated are numerous, and figuring out which is best for which patient can be complicated.
This section of the website presents information on the evaluation and management of peripheral nerve injury patients.  The By Region and By Nerve sections are deliberately redundant--similar information on the examination of the peripheral nerve motor or sensory end organ is presented but is organized differently, and one or the other may be useful depending on the patient injury pattern or treatment dilemma.
 
The General Information section reviews the following:
• The work-up of any peripheral nerve injury patient from history through physical exam and diagnostic testing.
• The non-operative treatment strategies that may be applied such as physical therapy and pain management.
• Descriptions of the various surgical interventions (nerve repair, nerve decompression, nerve transfer, etc.) that may be applicable to your patient--however step-by-step details for specific surgical procedures are found in the Surgical Options section.
• It is impossible via this resource to provide a precisely correct treatment plan for the patient arriving in your office or emergency room.  We can provide case examples and management strategies to help your thinking process.
The By Region section reviews the following:
• Physical examination of the peripheral nerve end organ organized by anatomic region.
• This will allow you to think through the exam of all the major regions of the extremity from shoulder to fingers.
• It also presents the exam of the brachial plexus and the extremity sensory exam.
• The examination of each muscle and each sensory nerve is illustrated by the use of photos, video and text.
The By Nerve sections reviews the following:
• Physical examination of the peripheral nerve end organ organized by nerve.
• This will allow you to think through the exam of all the major peripheral nerves of the extremity by the nerve in question--this will allow you to carefully examine both nerves that you think are injured as well as those that you might use as a donor nerve for nerve transfer procedure.
• The examination of each muscle and each sensory nerve is illustrated by the use of photos, video and text.
Also, in other sections of the website you will find:
• Anatomy and Physiology, including the background pathophysiology of nerve injury. Understanding this information is critical background for diagnosis and treatment -- consider reviewing this section.
• Surgical Options, including step-by-step surgical tutorials with intraoperative, narrated videos.
• Case Studies section, including case examples that will walk you through clinical scenarios that may be similar to that of the patient you are treating.