Repair of Peroneal Nerve Laceration

Trauma: Repair of Severed Nerve

Animation: Two views of a post-operative neuroma at site of failed nerve repair.

This animation depicts two views of a post-operative neuroma at the site of a failed nerve repair in a lacerated peroneal nerve.

The use of imaging to monitor the progress of a nerve repair may allow time to correct any problems with the initial repair.

Suture repair of nerves often provides an opportunity to recover function after severe trauma. Currently the introduction of nerve tubes for the repair of severed nerves has led to a great reduction in the length of surgical operations for nerve repair and has led to improved resutls for recovery and regrowth of severed nerves.

Regrowth of Severed Nerves

Trauma: Regeneration & Regrowth of Nerves After Severe Trauma

Animation: Image diagnosis of eight-year-old boy with partial reinnervation of right leg muscles.

The animation depicts the right-leg muscles of an eight-year-old boy with partial reinnervation eight months after being struck by a motor vehicle. Initially he had flaccid paralysis of the sciatic innervated muscles but by five months began to develop flexion at the knee which was 4/5 strength at the time of the imaging exam.

(A1) - Sagittal image of right thigh showing the femur fracture (fx), damaged sciatic nerve (sc) and patella (pat) for orientation.

(A2) -  The sciatic nerve was fully transected by the initial injury and its healed stump is seen with marked nerve injury hyperintensity. Several new growth nerves are seen emerging from the stump to reinnervate the long head of the biceps femoris. (TSN) - truncated sciatic nerve. (NGN) - new growth nerve reinnervating biceps.

(B1) - The semitendinosus and semimembranosus demonstrate muscle denervation hyperintensity (*).

(B2) - The short head of the biceps femoris (**) also continues to demonstrate hyperintensity of denervation.

(C) - Axial image three inches below the level of the sciatic stump (ps(C)) demonstrating the hyperintense semimembranosus and semitendinosus (*) and short head of the biceps femoris (**). There is normal muscle image appearance in the long head of the biceps femoris (***). The femur (fe) is labeled for orientation and the placement of the sagittal image slices for B1 and B2 are also marked ps(B1) and ps(B2).

Lingual Nerve Injury

Trauma: Lingual Nerve Injury from Dental Extraction

Animation: Injury associated nerve image hyperintensity and swelling at a site of nerve trauma.

This example illustrates an injury associated nerve image hyperintensity and swelling at a site of nerve trauma (*) resulting from an oral surgery procedure.

The lingual and inferior alveolar components of the mandibular nerve (M) are well seen.

The image findings confirm the traumatic origin of the numbness and pain experienced by the patient after the extraction.

Obstetrical Brachial Plexus Palsy

Trauma: Obstetrical Brachial Plexus Palsy from Birth Trauma

Animation: Image diagnosis of nerve disruption in obstetrical brachial plexus palsy.

(A) Three-month-old child with complete flail arm. Image demonstrates absence of plexus elements in area of trunks. A hypointense round (r) abnormality proved to be a mass of disrupted scarred scalene muscle partially incorporating shards of nerve remnants. In this situation, nerve grafts can be used to bridge gaps. In addition, neuroplasty or removal of adhesions helps improve recovery.

(B) Six-month-old child with persistent upper trunk paresis. Imaging confirmed ball neuromas at C5 and C6 demonstrating complete disruption of upper trunk elements. Early demonstration of complete disruption with terminal nerve neuromas can allow for an earlier decision for restorative surgery and hence better outcomes.

Brachial Plexus Trauma

Trauma: Diagnosis of Traumatic Discontinuities in Brachial Plexus Elements

Animation: Confirmation of total nerve disruption in trauma.

(A) The right brachial plexus of a 15-year-old with flail arm - lacking any movement or sensation, two months after a motorcycle accident.  The image demonstrates gross discontinuities ro disruptions in the upper plexus elements (ue), meningocoeles proximally (me), and bright swollen nerve trunks (st).

(B) Disconnected and retracted lower trunk (lt) in traumatic injury of brachial plexus.