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Invited Review: Combat-related peripheral nerve injuries
Invited Review: Combat-related peripheral nerve injuries
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Abstract

Active-duty service members (ADSM) and military Veterans represent a population with increased occupational risk for nerve injuries sustained both during training operations and wartime. Mechanisms of war-related nerve injuries have evolved over time, from the musket ball-related traumas described by S.W. Mitchell to complex blast injuries and toxic exposures sustained during Middle East conflicts in the 21st century. Commonly encountered nerve injury etiologies in this population currently include compression, direct trauma, nutritional deficits, traumatic limb amputation, toxic chemical exposures, or blast-related injuries. Expeditious identification and comprehensive, interdisciplinary treatment of combat-associated neuropathies, as well as prevention of these injuries whenever possible is critical to reduce chronic morbidity and disability for service members and to maintain a well-prepared military. However, diagnosis of a combat-associated nerve injury may be particularly challenging due to comorbid battlefield injuries or delayed presentation of neuropathy from military toxic exposures. Advances in imaging for nerve injury, including MRI and ultrasound, provide useful tools to compliment EMG in establishing a diagnosis of combat associated nerve injury, particularly in the setting of anatomic disruption or edema. Surgical techniques can improve pain control or restoration of function. In all cases, comprehensive interdisciplinary rehabilitation provides the best framework for optimization of recovery. Further work is needed to prevent combat-associated nerve injuries and promote nerve recovery following injury.

Objectives: The objectives of this activity are to: (1) Understand and be able to diagnose the fundamental features of peripheral nerve combat injuries due to compression, direct trauma, nutrition, amputation, nutritional deficiencies, toxic chemicals, and blasts; (2) properly select and employ electrodiagnostic studies, ultrasound, and magnetic resonance imaging in the evaluation of combatrelated peripheral nerve injuries; (3) Understand and effectively select and employ the essential steps and procedures in the treatment of combat-related peripheral nerve injuries.


ACCREDITATION STATEMENT
The AANEM is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.


CREDIT DESIGNATION
The AANEM is accredited by the American Council for Continuing Medical Education (ACCME) to providing continuing education for physicians. AANEM designates this Journal-based CME activity for a maximum of 1.0 AMA PRA Category 1 Credit™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

DISCLOSURE INFORMATION
The authors had no financial conflicts of interest.


FORMAT
PDF
Authors
Ileana M. Howard MD, Kaye Sedarsky MD, Michael Gallagher MD, Matthew Miller MD, Ross C. Puffer MD
Summary
Availability: On-Demand
Expires on Jun 06, 2027
Cost: Member: $0.00
Non-Member: $25.00
Credit Offered:
1 CME Credit
1 CEU Credit


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