Paradoxical clinical consequences of peripheral nerve injury: conduction of nerve impulses does not occur across the site of injury immediately following nerve division and repair.
The occasional apparent clinical phenomenon of the immediate although transient return of peripheral nerve function after nerve division and primary repair has been previously reported. Electrophysiological findings from the sciatic nerve of the rabbit have been previously presented in support of the concept of the transmission of nerve impulses across a freshly divided and repaired peripheral nerve for a short period until the onset of Wallerian degeneration. This paper presents experimental evidence to show that these findings were misinterpreted and that a compound action potential cannot be transmitted across a surgically repaired division in a peripheral nerve. Observations from previous experimental research in neurophysiology are discussed which confirm these conclusions. The claim that failure to diagnose a peripheral nerve injury at presentation can be explained in some circumstances by "jump transmission" is not based on sound evidence and the concept of "jump transmission" cannot be accepted as a defence for clinicians who fail to diagnose a peripheral nerve injury.
McAllister
R M
RM
RAFT Institute of Plastic Surgery, Mount Vernon Hospital, Northwood, Middlesex, UK.
Calder
J S
JS
D000200:Action Potentials; D000818:Animals; D004558:Electric Stimulation; D005260:Female; D009431:Neural Conduction / Q000502:physiology*; D010543:Peroneal Nerve / Q000293:injuries* / Q000503:physiopathology / Q000601:surgery; D051381:Rats; D011917:Rats, Inbred Lew; D012584:Sciatic Nerve / Q000293:injuries* / Q000503:physiopathology / Q000601:surgery