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Management Overview

Be sure to figure out the following before making a treatment plan:

• What is the injury?  Is it open, closed, or a gun shot/blast wound?
• When did it happen?  Is it acute, subacute or chronic process? Is the presentation early or late? Is the patient getting better/showing improvement in function over time?
• Where is the injury?  Is it central or peripheral nervous system?  If it is the peripheral nervous system, is it at the nerve root, brachial plexus, or peripheral nerve level?

The management of peripheral nerve injuries may include any of the following:

• Close observation, physical therapy and medical management of neuropathic pain.
• Combinations of direct surgical exploration and repair, nerve and tendon transfers, decompression and many other procedures. 

This section, will take you through the management of patients with peripheral nerve disorders.  The overall management strategies are reviewed:
• Nerve injuries and patients with these injuries are complex; each case must be treated individually.  Algorithms or treatment strategies based on a diagnosis provide guidelines and a framework for formulating a treatment plan.  However, individualized (for the patient) creative thinking is imperative.
• 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 guide your thinking.
• This section reviews overall management strategies by broad subject matter including:
• Type of injury seen -- open, closed, gunshot/blast, closed brachial plexus, compressive neuropathy, neuroma.
• Loss of function seen -- upper or lower plexus; axillary, radial, musculocutaneous, median, ulnar nerve.
• Imaging and electrodiagnostic testing
• Physical therapy
• Pain management
In other sections of the website, you will find:
• In the Surgical Options section, descriptions of procedures with exact surgical steps.
• In the Case Studies section, case examples that walk you through clinical scenarios that may be similar to that of the patient you are treating.
• In the Anatomy and Physiology section, the background pathophysiology of nerve injury may be found, and understanding this information is critical for diagnosis and treatment -- consider reviewing this section.