Neuropraxia - Causes, Symptoms, Diagnosis, and Treatment

Creator: Dr. Osheen Kour
Published: 2023-04-03T13:25:58

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The mild peripheral nerve injury called neuropraxia can cause temporary sensory and motor loss. Read the article to know more about it.

Written by

Dr. Osheen Kour

Medically reviewed by

Dr. Abhishek Juneja

April 3, 2023

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Contents

What Are the Various Types of Neuropraxia?
What Are the Causes of Neuropraxia?
What Are the Symptoms of Neuropraxia?
How Is Neuropraxia Diagnosed?
What Is the Treatment for Neuropraxia?
What Is the Differential Diagnosis for Neuropraxia?
What Are the Complications Associated With Neuropraxia?

Introduction:

Neuropraxia is peripheral nerve injury causing motor and sensory loss by affecting the nerve conduction in the affected area. Neuropraxia is a grade 1 peripheral nerve injury that blocks the injured nerve and prevents the transmission of signals (electrical). The affected site remains out of communication from the rest of the body until the nerve block is cleared and the signal transmission is resumed. The condition may be caused due to any injury from accidents, sports, surgical trauma, etc. Typically these mild peripheral injuries get to recover on their own, but if the pain is persistent, medical and surgical intervention may be needed. Therefore, a person should take necessary safety measures to prevent such incidents and wear protective gear such as helmets, knee pads, and other equipment.

What Are the Various Types of Neuropraxia?

The various types of neuropraxia occur at different sites of injury. These include

Brachial Plexus Neuropraxia: In this shoulder or branchial nerves are damaged due to an injury. These branchial nerves carry impulses or signals from the spinal cord to the arms and hands and cause symptoms in one arm.
Axillary Neuropraxia: Axillary nerve damage caused by an injury causes symptoms in the arms, shoulders, and hands. These nerves carry impulses from the shoulder joint and arm muscles.
Sural Nerve Neuropraxia: Sural nerves are present between the calf, heels, foot, and brain to transmit impulses. Therefore, damage to the sural nerve causes neuropraxia in these regions, and symptoms occur mainly in the foot and ankle.
Radial Nerve Neuropraxia: Radial nerve injury causes the symptoms in hand and back of the arm. The radial nerve carries signals in these regions, which are affected by neuropraxia, and symptoms are felt in the hand's index and middle fingers, thumb, and back.

What Are the Causes of Neuropraxia?

Neuropraxia is mainly caused due to ischemia (low blood supply in the tissues) and compression. Also, inflammation can be a cause of neurapraxia. Neuropraxia is caused by various reasons, such as:

Surgical Complications:

Poor padding of body supports.
Poor body positioning during surgeries.
Anesthesia-related complications cause chemical nerve damage or blood supply cut off by narrowing the vessels.
Complications caused by ACL (anterior cruciate ligament reconstruction) may also occur during hip replacement surgeries.

Traumatic Neuropraxia:

Dislocation.
Bone fractures.
Injuries and tears to tendons and ligaments.

Other Causes:

Giving birth.
Tooth extractions.
Endodontic procedures.

What Are the Symptoms of Neuropraxia?

Neuropraxia symptoms may not occur soon after the injury but can appear after a few weeks. It may be due to inflammation-causing nerve damage by compressing the nerve. The symptoms of neuropraxia caused by blood loss are short-term, whereas those caused by compression are long-lasting and form a neural blockage. Symptoms of neuropraxia are as follows.

Numbness.
Pain.
Weakness.
Tingling.
Burning.
Stinging.
Loss of motor abilities.
Loss of sensations.
Touch sensitivity.

How Is Neuropraxia Diagnosed?

The healthcare provider diagnoses the neuropraxia by physical examination of the patient. The doctor also advises various laboratory blood tests, such as kidney function, complete blood count, liver function, blood glucose, vitamin B12 levels, thyroid function, and erythrocyte sedimentation rate.

In addition, a needle EMG (electromyogram) study is performed on the patient starting from day two or three up to day six and is done routinely every six weeks. The test helps identify nerve and muscle health during an injury and indicates any defects in nerve-to-muscle impulse transmission, nerve damage, or muscle dysfunction.

Also, peripheral nerves and muscles are examined through an ultrasound to identify the nerve continuity. Computed tomography (CT scans) also help identify the unreduced bone fractures that may cause compression of the nerves and muscles in the affected body area.

The doctor also recommends magnetic resonance imaging (MRI) of the pelvis and lumbar spine to identify the source of nerve compression causing neuropathy. MRI is usually done immediately after any postoperative and traumatic injuries.

What Is the Treatment for Neuropraxia?

The doctor usually manages neuropraxia by using conservative treatment methods. The doctor mainly recommends limb support, physical rehabilitation, splints, avoiding physical activities, and avoiding neuropathic medications for pain, such as antidepressants, analgesics, corticosteroids, anticonvulsants, etc.
Hematoma nerve compressions are immediately decompressed, and in case of compressions due to trauma or fractures, surgical decompression is needed.
Fasciotomy may also be required in case of compartment syndrome.
If there is no recovery in a patient after three to six months, surgical treatment may be required to manage the scar tissue that might be preventing the recovery. The doctor performs nerve decompression and transposition to treat the patient.
Physical rehabilitation is done by managing pain and providing psychological support to the patient. Pain management is very challenging in peripheral nerve damage cases as dysesthesia and burning sensation is produced along the nerve distribution. In such cases, the doctor may prescribe anticonvulsants, tricyclic antidepressants, baclofen, and some short-term treatment with NSAIDs (nonsteroidal anti-inflammatory drugs), opioids, and Tramadol.
In addition, the doctor advises the patients to take precautions to avoid repetitive injury.

What Is the Differential Diagnosis for Neuropraxia?

Neuropraxia condition of the nerves can resemble various muscles and nerve illnesses. Therefore, the diagnosis should be made cautiously by the doctor. These differential diagnoses include:

Axonotmesis.
Inflammatory neuritis.
Myelopathy.
Muscle diseases.
Diabetic neuropathy.
Paraneoplastic neuropathy.
Upper neuron disease.
Radiculopathy.
Neurotmesis.
Spinal cord trauma.
Infectious neuropathy, such as leprosy.

What Are the Complications Associated With Neuropraxia?

Psychological issues.
Long-term neuropathic pain, weakness, and numbness.
Muscle atrophy due to improper diagnosis.
Economic losses.
Tissue scars at the injury sites.
Inflammation.

Conclusion:

Patients suffering from neuropraxia usually recover within two to three months after an injury. The prognosis for the condition is very good; however, neuropraxia from major injuries can cause permanent damage in approximately 30 percent of cases. Neuropraxia is a very mild form of peripheral nerve injury and may arise from paresthesias, transient weakness, and nerve conduction blockage at the injury site. Therefore, a person suffering from neuropraxia should take all the necessary precautions advised by the doctor and keep the healthcare provider informed and updated about their recovery process and healing.

Frequently Asked Questions

1. What Example Illustrates Neuropraxia?

An example of neuropraxia might be when someone experiences a "pins and needles" sensation or temporary numbness in their arm or leg after falling asleep in an awkward position. In this case, the nerve function is temporarily impaired due to pressure or compression, but it typically returns to normal after changing the position and relieving the pressure on the nerve.

2. How Does Neuropraxia Typically Heal or Recover?

The healing process of neuropraxia involves the recovery of nerve function after a temporary disruption caused by compression, stretching, or another external factor. Once the pressure on the nerve is relieved, the symptoms associated with neuropraxia, such as numbness, tingling, or weakness, should gradually subside. This may occur over a period of minutes to hours, and in some cases, it may take a few days to a few weeks.

3. What Categories Do Nerve Injuries Fall Into?

Nerve injuries can be classified into three main types, each with varying degrees of severity and potential for recovery. Neuropraxia is the mildest and most common type of nerve injury. It involves a temporary loss of nerve function without any structural damage to the nerve itself. Axonotmesis is a more severe nerve injury compared to neuropraxia. In this type of injury, there is damage to the nerve fibers (axons), but the connective tissue surrounding the nerve (endoneurium, perineurium, and epineurium) remains intact. Neurotmesis is the most severe type of nerve injury and involves complete severing or disruption of the nerve, including both the nerve fibers and the surrounding connective tissue.

4. How Does Neuropraxia Differ From Axonotmesis?

Neuropraxia is the mildest form of nerve injury. It involves a temporary loss of nerve function without any structural damage to the nerve itself. The nerve remains intact, but its conduction is temporarily disrupted due to compression, stretching, or some other external factor. Axonotmesis is a more severe nerve injury compared to neuropraxia. In axonotmesis, there is damage to the nerve fibers (axons), but the connective tissue surrounding the nerve (endoneurium, perineurium, and epineurium) remains intact.

5. What Sets Neuropraxia Apart From Neurotmesis?

Neuropraxia is the mildest form of nerve injury. Neurotmesis is the most severe type of nerve injury. It involves complete severing or disruption of the nerve, including damage to both the nerve fibers (axons) and the surrounding connective tissue (endoneurium, perineurium, and epineurium).

6. Can Nerve Damage Be Detected Through an MRI Scan?

MRI (Magnetic Resonance Imaging) is a useful diagnostic tool for visualizing various structures within the body, including soft tissues like nerves. However, the ability of an MRI to detect and assess nerve damage depends on several factors, and it may not always provide a complete picture of nerve injuries, especially in cases of milder nerve injuries like neuropraxia.

7. What Medications Are Commonly Prescribed to Treat Neuropraxia Effectively?

There is no specific medication that can be typically used to treat neuropraxia because neuropraxia is primarily a temporary and mild nerve injury that often resolves on its own once the underlying cause of the injury is addressed. The key to managing neuropraxia is to relieve the pressure, compression, or stretching that caused the nerve disruption and allow the nerve to naturally recover.

8. What Initial Symptoms Indicate Nerve Damage?

The signs of nerve damage can vary depending on the location of the affected nerves and the extent of the injury. Nerve damage can affect sensory, motor, or autonomic nerves, and the symptoms can manifest in a variety of ways. Numbness, tingling, or a "pins and needles" sensation can be early signs of nerve damage. These sensations often occur in the hands, feet, or other extremities.

9. How Does Radiculopathy Differ From Neuropraxia?

Radiculopathy and neuropraxia are two distinct medical conditions that affect nerves, and the key difference between them lies in their nature, causes, and symptoms. Radiculopathy is a condition that primarily involves the compression, irritation, or inflammation of nerve roots as they exit the spinal cord. Neuropraxia is a type of nerve injury characterized by temporary and reversible loss of nerve function without structural damage to the nerve itself.

10. How Does Neuropraxia Relate to Falling Injuries?

Neuropraxia after a fall refers to a specific type of nerve injury that occurs as a result of trauma or impact from a fall. In the context of a fall, neuropraxia may occur when there is external pressure, stretching, or compression on a nerve due to the impact of the fall. This can lead to a disruption in nerve conduction, resulting in symptoms such as temporary numbness, tingling, or muscle weakness in the affected area.

11. Is Massage Therapy Beneficial in Treating Neuropraxia?

Massage can potentially be beneficial for individuals with neuropraxia, but its effectiveness may depend on the specific circumstances and the guidance of a healthcare professional. Massage should be administered with caution in cases of neuropraxia, especially if the specific cause of the nerve injury is not well understood. Applying too much pressure or manipulation to the affected area may exacerbate the condition or cause discomfort.

12. How Long Does the Nerve Healing Process Typically Last?

The healing of nerves can vary significantly depending on the type and severity of the nerve injury, as well as individual factors. The type of nerve injury plays a crucial role in determining the duration of healing. Neuropraxia, a mild form of nerve injury, often heals relatively quickly and may resolve within weeks to months once the underlying cause is addressed. More severe nerve injuries like axonotmesis or neurotmesis may require longer healing times and may not achieve full recovery.

13. What Are the Treatment Options for Neuropraxia Specifically Affecting the Foot?

The first step in treating neuropraxia in the foot is to rest the affected foot and avoid activities or positions that may further exacerbate the nerve injury. This may include refraining from activities that place undue pressure or strain on the foot or that caused the injury in the first place. Wearing a brace, splint, or protective footwear may help support and protect the injured foot while it heals. These devices can also help prevent further damage.

14. Can Neuropraxia Be Reversed?

Yes, neuropraxia is generally reversible. Once the underlying cause of the nerve injury is resolved, such as by relieving the compression or stretching, nerve function typically returns to normal. This reversal of symptoms is one of the defining characteristics of neuropraxia.

15. What Does It Mean to Have Neuropraxia in the Right Ulnar Nerve?

The ulnar nerve is one of the major nerves in the arm and hand. Neuropraxia of the right ulnar nerve refers to a temporary disruption of the nerve function in the right ulnar nerve, typically resulting from compression, stretching, or some other external factor. This can lead to symptoms such as temporary numbness, tingling, or muscle weakness in the area of the arm and hand supplied by the ulnar nerve.

Sources

Dr. Abhishek Juneja

Neurology

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