Clinical Anatomy and Diagnostic Challenges in Peripheral Nerve Trauma for the Forensic Physician

Abstract

Peripheral nerve injuries represent a significant challenge in legal medicine, and their proper management and evaluation are at the intersection of clinical medicine, anatomical science, and legal medicine. In this review, we aimed to integrate current knowledge about the anatomy, physiology, clinical management, and paraclinical assessment of peripheral nerve injuries, targeted explicitly for medical-legal practice. We conducted a comprehensive review of the medical-legal evaluation framework needed to evaluate peripheral nerve injuries, with particular emphasis on anatomical variations, imaging techniques, and methods to assess the timing of injury. Peripheral nerve injuries should be analyzed using a complex approach, which includes anatomical characteristics, variants, microanatomy, physiopathology, imaging, and other paraclinical evaluations. The analysis of causation and timing of injury should be heavily based on objective criteria and should be performed using a reproducible, objective, and scientifically based approach.

Keywords: forensic pathology; legal medicine; malpractice; peripheral nerve trauma.

Figure 1

The overall structure of a nerve, containing (1)—an outer layer (epineurium), encasing the nerve, (2)—an intermediary layer (perineurium), encasing multiple nerve fibers, and (3)—an inner layer (endoneurium), encasing each nerve fiber (4). Within the nerve fiber are present nutritional vessels (5).