What is the treatment for a bruised nerve?

Treatment of Bruised Nerve

The treatment of a bruised nerve (peripheral nerve contusion) should focus on rest, anti-inflammatory medications, and physical therapy, with surgical intervention reserved for cases that don't improve after 3 months of conservative management. 1

Understanding Nerve Contusions

• A bruised nerve (contusion) occurs when a peripheral nerve is compressed or traumatized but not completely severed, causing inflammation and temporary dysfunction 1
• Unlike lacerations or complete transections, contused nerves have potential for spontaneous recovery without surgical intervention 1, 2
• Recovery occurs at approximately one inch per month, with better outcomes typically seen in distal rather than proximal injuries 1

Initial Management (First 3 Months)

Conservative Treatment

• Rest the affected area and avoid positions or movements that aggravate symptoms 3
• Anti-inflammatory medications to reduce swelling around the nerve:
  • NSAIDs for pain control and inflammation reduction 4
  • In select cases, a short course of oral corticosteroids may help reduce inflammation 4
• For localized nerve pain, topical agents can be beneficial:
  • Lidocaine 5% patches for localized neuropathic pain with minimal systemic side effects 3
  • High-concentration capsaicin for localized pain 3

Pain Management

• For neuropathic pain symptoms, consider:
  • Pregabalin as first-line therapy due to its predictable pharmacokinetics 3
  • Gabapentin as an alternative first-line option, though it requires more careful dosing 3
  • Duloxetine (SNRI) as a second-line treatment option 3
  • Tricyclic antidepressants (nortriptyline or desipramine) at low initial doses (10-25mg) as third-line options 3

Physical Therapy

• Gentle range of motion exercises to prevent stiffness in affected joints 4
• Nerve gliding exercises may be beneficial, though evidence is limited 5
• Splinting may be necessary in some cases to protect the nerve from further injury 5

Monitoring and Follow-up

• Regular assessment of nerve function using validated tools to track recovery 3
• Electromyography (EMG) and nerve conduction studies at 3 months if no functional recovery has occurred 1
• Patient education about the trial-and-error nature of treatment and expected recovery timeline 3

Surgical Intervention

• Surgical exploration and repair is indicated if:

  • No functional recovery has occurred after 3 months of conservative management 1
  • EMG and nerve conduction studies confirm ongoing nerve dysfunction 1
  • The nerve injury is within 18 inches of the target muscle (as recovery beyond this distance is less likely) 1

• Surgical options may include:

  • Simple decompression to relieve pressure on the nerve 5
  • In severe cases where the nerve is partially damaged, repair of the nerve may be necessary 6

Special Considerations

• Recovery is possible for up to 18 months following injury 1
• Distal nerve injuries generally have better outcomes than proximal ones due to shorter regeneration distances 1
• Multidisciplinary approach including pain management, physical therapy, and psychological support may be necessary for optimal outcomes 4
• Patients should be educated about avoiding prolonged movements or positions that may aggravate the injury 5