The timeframe of surgical repair is an important factor in recovery. Within 18 months, the muscles that have not already connected to nerves may have weakened to the point where it is no longer possible.
For avulsion and rupture injuries, there is no potential for full recovery unless surgical repair is done in a timely manner. For neuroma and neurapraxia injuries, the potential for improvement varies. Most patients with neurapraxia injuries have a fair prognosis of recovering spontaneously with a 90-100 percent return of function.
If surgery is needed, microsurgical nerve repair may be undertaken as early as 3 months. Primary nerve repair is typically completed by approximately 6 months of age.
Removal of the constrictive scar tissue surrounding the nerve.
When the neuroma is large it must be removed and the nerve is then reattached either with end-to-end techniques or with nerve grafts.
When the gap between the nerve ends is so large that it is not possible to have a tension-free repair using the end-to-end technique, nerve grafting is used.
This is used generally in those cases where there is an avulsion. Donor nerves are used for the repair. The parts of the roots still attached to the spinal cord can be used as donors for avulsed nerves.
Isolated Nerve Transfers
- Isolated transfer may be completed up to 12-18 months of age
- A nearby healthy nerve is attached to the damaged nerve, closer to the target muscle
Additional procedures are available to improve the overall function of the affected limb.
- Arthroscopic surgery and other minimally invasive techniques
- Tendon transfers
- Muscle transfers
- Shoulder reconstruction
- Rotational osteotomies
- Elbow reconstruction