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H H S Department of Health and Human Services
U.S. Department of Health and Human Services
Health Resources and Services Administration

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Nerve Impairment

Early identification of nerve changes and consideration of treatment is important in prevention of disability.

"There is no better treatment than if the problem had not been allowed in the first place" - Paul W. Brand

Nerve impairment can be interrupted at an early stage before impairment of sweat, sensory and muscle function are permanent and disability inevitable... The best disability prevention is early recognition of developing nerve complications BEFORE primary changes in nerve function have become permanent. The nerve branches do not usually lose function all at once. Sensory function of the nerve is almost always lost before muscle function, and often, unless the nerve involvement is acute and severe, there are subtle changes and mild sensory loss that can be observed and measured before there is severe loss. Nerves react very quickly and adversely to ischemia (loss of nutrition from the small blood vessels that supply the nerve fibers). A nerve that has been mildly or severely damaged for a short period may respond to treatment. A nerve that has been severely damaged even for a short period may not recover, but some patients with specific treatment of the nerve have been observed to improve even if nerve loss has been longstanding. Most of these will be patients who have had changes for less than 6 months, although patients have been observed to improve even if the condition has been a year or longer.

Nerves have an innate tendency to heal - The nerve, like other body tissue, has a natural tendency to heal itself. The nerve will try to recover even without treatment. Given the right circumstances, the nerve has a better chance to heal - reduction of swelling, minimization of mechanical stress during the time the nerve is changing in function and physician ordered administration of corticosteriods or other anti-inflammatory agents. It is the natural tendency of the nerve to heal that is taken advantage of in treatment. If factors causing the nerve to change in function are reduced such as swelling where the nerve travels through tight compartments or overuse of the extremity when the nerve is acute and painful, the nerves have been observed to improve and recover faster and more completely.

Even if a patient has had a partial loss in function that has been longstanding, it is still possible to see improvement back to earlier status if another episode of worsening occurs. For those who have developed another episode of loss, they may have been stabilized in function for a period. What has relatively recently changed can be improved.

Ebb and flow of nerve function - Some patient will undergo only one episode of nerve changes and then stabilize with treatment. For others, the picture of nerve loss once a nerve is involved is more often several episodes of worsening and improvement as the body tries to heal. If repeated episodes occur untreated, the general trend is for the nerve to progressively lose function and for more nerves to become involved. One cannot treat what is not recognized as a problem. Objective and sensitive measurements allow for improvements in treatment before damage is irreparable and lifelong.