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Axonotmesis is a severe nerve injury that disrupts the nerve’s axon and myelin sheath but leaves supporting structures intact. Symptoms range from pain to paralysis, and treatment includes managing pain and inflammation, injury management, and physical therapy. Nerves can regenerate, but it depends on the severity of the injury.
A nerve is a set of fibers, similar in structure to a cable, that is responsible for providing a path for electrochemical impulses to travel throughout the body. Axonotmesis is a term used to describe a severe nerve injury commonly seen in peripheral nerves that causes disruption of the nerve’s axon and myelin sheath but leaves the supporting structures of the cells intact. The peripheral nervous system, or PNS, are the auxiliary nerves that don’t include the brain or spinal cord. The axon of a nerve are the thin projections arising from the nerve cell body that carry signals away from the nerve. The myelin sheath is the electrically charged covering of the axon.
Axonotmesis typically does not affect the connective tissue structure of the nerve, including the epineurium and perineurium. The epineurium is the tough outermost protective layer of a nerve that contains blood vessels. The perineurium is the middle layer of connective tissue.
Injury to the axonotmetic nerve is usually sustained by a severe contusion, also known as a bruise or crush injury. However, it can also occur with a strain injury. Symptoms can range from pain to dysfunction, including paralysis. Paralysis can occur in the motor, sensory, or autonomic systems. Motor paralysis presents as the inability to move muscles or muscle groups. Paralysis of the sensory system disrupts the transport of electrochemical signals from the nerves. Paralysis of the autonomic system impedes the regulatory functions of the nerves which aids in the body’s ability to adapt to changes in the environment.
Nerves have the ability to regenerate or repair themselves as long as the damage is not excessive and the major portion of the nerve remains intact. Depending on the severity of the nerve injury known as axonotmesis, regeneration of the nerve may or may not occur. Nerve repair can take several months as regeneration is a slow process. In some cases, electrical stimulation can speed up the regeneration process.
Initially, a treatment protocol for axonotmesis includes conservative measures such as managing pain and inflammation with analgesics and anti-inflammatory drugs; injury management such as supports, reinforcements or throwing measures; and close observation to continually assess symptoms. Physical therapy can also be employed to aid in pain relief through specialized modalities such as ice application and ultrasound. A full regiment of stretching and exercise helps limit protective muscle spasms and maintain the strength and flexibility of surrounding muscles.
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