Recommendations for Patients with Complex Nerve Injuries during the COVID-19 Pandemic

Furthermore, reduced availability of in-person assessments could result in delayed identification of CNI, as in-person sensorimotor physical examinations are often key to identifying neurological deficits (e.g. anterior shoulder dislocation resulting in axillary nerve palsy could be missed without in-person orthopedic follow-up). [...]our strongest recommendation is an immediate referral of patients with CNI by primary treating physicians to their regional CNIP, through direct physician-to-physician communication to avoid delays. A virtual assessment cannot substitute for the nuances of an in-person physical examination, such as evaluating for the Medical Research Council Grade 1 recovery. [...]if there is any concern about impediments to spontaneous or postoperative neurological recovery, or if injury characterization cannot be clearly defined virtual, we recommend that referring physicians and CNIPs have a low threshold for performing an in-person assessment. Infection Control In order to provide safe, in-person visits, CNIPs must adhere to infection control measures according to prescribed public health recommendations with guidance from local hospital leadership.8 Consideration must be given to infection control in both clinical and surgical settings, with recommendations evolving with an improved understanding of COVID-19. [...]consensus is evolving on requirements for full personal protective equipment (PPE) use during surgery and CNI surgical teams may be sufficiently protected using droplet precautions only (thereby reducing PPE usage).9 We endorse the recent recommendations published by the American Association for Neuromuscular & Electrodiagnostic Medicine regarding general infection control measures for the resumption of routine electrodiagnostic testing.10 Infection control factors particularly germane to the evaluation and treatment of CNI are outlined in Table 2.