In general, recovery from nerve injury can be viewed as occurring in three phases.
• Acute phase: This is early after injury or after surgery, when the emphasis is on healing and prevention of complications.
• Recovery phase: This is when reinnervation occurs. Emphasis is on retraining and re-education.
• Chronic phase: This occurs when the potential for reinnervation has peaked and there are significant residual deficits. The emphasis is training compensatory function.
Management needs to consider not only nerve healing but tissue healing in general.
Acute Phase
Following injury or immediately after surgery (e.g., following decompression and release or following repair of a lacerated nerve), there may be a brief period of immobilization to protect the nerve, minimize inflammation, and minimize tension at the injured/repaired site. As soon as allowed:
• Movement. Begin range of motion (ROM) to minimize joint and connective contractures and adhesions. This is dictated by the surgeon and type of surgery.
• Splinting or bracing. Splinting or bracing may be necessary to prevent deformities due to strength imbalances (use of a radial nerve splint to prevent wrist drop, a median nerve splint to position the thumb in opposition, a plantarflexion splint to prevent foot drop) and to prevent undue stress on the healing nerve tissue.
• Patient education. The patient must learn to protect the extremity to avoid injury due to loss of sensation.

Management Guidelines-Recovery from Peripheral Nerve Injury
Acute phase: immediately after injury or surgery
• Immobilization: time dictated by surgeon
• Movement: amount and intensity dictated by type of injury and surgical repair
• Splinting or bracing: may be necessary to prevent deformities
• Patient education: protection of the part

Recovery phase: signs of reinnervation (muscle contraction, increased sensitivity)
• Motor retraining: muscle “hold” in the shortened position
• Desensitization: multiple textures for sensory stimulation; vibration
• Discriminative sensory reeducation: identification of objects with, then without, visual cues
Chronic phase: reinnervation potential peaked with minimal or no signs of neurological recovery
• Compensatory function: compensatory function is minimized during the recovery phase but is emphasized when full neurological recovery does not occur
• Preventive care: emphasis on lifelong care to involved region

Recovery Phase
The recovery phase begins with signs of reinnervation (volutional muscle contraction and hypersensitivity). With nerve regeneration and recovery, begin:
• Motor retraining. When signs of volutional muscle contraction occur, the muscle is positioned in its shortened position; the patient is asked to hold. Electrical stimulation may be used to reinforce this active effort. When the muscles demonstrate control of some range, begin gravity-eliminated, active-assistive ROM. Continue to protect the weak muscles with a splint or brace.
• Desensitization. As nerves regenerate, the person experiences increased sensitivity (hypersensitivity) in the area that had previously been without sensation. Use a graded series of modalities and procedures to decrease the irritability and increase awareness.

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