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Nerve palsy — Clinical Guidelines

Overview

Nerve palsy refers to the dysfunction of a nerve leading to impaired motor, sensory, or autonomic function, commonly affecting cranial nerves (e.g., facial, brachial plexus) or peripheral nerves (e.g., radial, common peroneal).

Diagnosis

Clinical Presentation: Characteristic symptoms based on affected nerve (e.g., foot drop for common peroneal nerve palsy, facial weakness for facial nerve palsy).

Imaging: MRI or CT scans to identify structural causes (e.g., temporal bone fractures 11).

Electromyography (EMG): Useful for assessing nerve conduction and muscle function 1.

Grading Systems: Yanagihara grading for facial nerve function 4.

Management

Common Peroneal Nerve Palsy: Treatment varies by mechanism of injury; individualized approaches based on systematic review findings 1.

Brachial Plexus Palsy: Multidisciplinary management including surgical options like lower trapezius transfer for shoulder function 3.

Facial Nerve Palsy: Conservative management initially; surgical interventions like hypoglossal nerve transfer in obstetric cases 8.

Recurrent Nerve Disorders: Phoniatric interventions including functional retraining and manual therapy 6.

Special Populations

Neonates: Neonatal brachial plexus palsy risk factors include difficult vaginal deliveries 2.

Pediatrics: Isolated radial nerve palsy in newborns often resolves spontaneously 9.

Elderly: Specific considerations for comorbidities and surgical risks in elderly patients undergoing nerve reconstructive surgeries are implied but not explicitly detailed.

Key Recommendations

Tailor treatment for common peroneal nerve palsy based on injury mechanism, guided by systematic review findings (Evidence: Strong 1).

Consider multidisciplinary clinics for comprehensive facial nerve palsy management, enhancing patient outcomes (Evidence: Moderate 7).

Evaluate and manage neonatal brachial plexus palsy with awareness of delivery-related risk factors (Evidence: Moderate 2).

Explore hypoglossal nerve transfer as a viable surgical option for significant obstetric brachial plexus palsy with careful assessment of donor site morbidity (Evidence: Weak 8).

Use three-dimensional helical CT for accurate classification and surgical planning in temporal bone fractures associated with facial nerve injury (Evidence: Moderate 11).

References

1 Klifto KM, Azoury SC, Gurno CF, Card EB, Levin LS, Kovach SJ. Treatment approach to isolated common peroneal nerve palsy by mechanism of injury: Systematic review and meta-analysis of individual participants' data. Journal of plastic, reconstructive & aesthetic surgery : JPRAS 2022. link 2 Vakhshori V, Bouz GJ, Alluri RK, Stevanovic M, Ghiassi A, Lightdale N. Risk factors associated with neonatal brachial plexus palsy in the United States. Journal of pediatric orthopedics. Part B 2020. link 3 Clouette J, Leroux T, Shanmugaraj A, Khan M, Gohal C, Veillette C et al.. The lower trapezius transfer: a systematic review of biomechanical data, techniques, and clinical outcomes. Journal of shoulder and elbow surgery 2020. link 4 Sekikawa K, Moriyama H, Miyaso H, Osada T, Ueno R, Otsuka N et al.. Evaluation of Yanagihara facial nerve grading system based on a muscle fiber analysis of human facial muscles. European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery 2019. link 5 Utz ER, Wise SR. Navy diver with recurrent facial nerve baroparesis treated with eustachian tube balloon dilation. The Laryngoscope 2019. link 6 Faure MA. Phoniatric management of 3 clinical cases of voice disorders involving the recurrent nerve. Revue de laryngologie - otologie - rhinologie 2012. link 7 Sadiq SA, Usmani HA, Saeed SR. Effectiveness of a multidisciplinary facial function clinic. Eye (London, England) 2011. link 8 Blaauw G, Sauter Y, Lacroix CL, Slooff AC. Hypoglossal nerve transfer in obstetric brachial plexus palsy. Journal of plastic, reconstructive & aesthetic surgery : JPRAS 2006. link 9 Deshmukh NV, Phillips GE. Isolated radial nerve palsy in a newborn: report of two cases. Hand surgery : an international journal devoted to hand and upper limb surgery and related research : journal of the Asia-Pacific Federation of Societies for Surgery of the Hand 2002. link 10 Sandmire HF, DeMott RK. Erb's palsy causation: a historical perspective. Birth (Berkeley, Calif.) 2002. link 11 Yanagihara N, Murakami S, Nishihara S. Temporal bone fractures inducing facial nerve paralysis: a new classification and its clinical significance. Ear, nose, & throat journal 1997. link 12 Lowe DM, McCullough AM. 7th nerve palsy after extradural blood patch. British journal of anaesthesia 1990. link 13 Feibel RM. Robert E. Wright and the development of facial nerve akinesia. Survey of ophthalmology 1989. link90054-4) 14 Laha RK, Panchal P. Isolated accessory nerve palsy. Southern medical journal 1979. link

Nerve palsy