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PERIPHERAL NERVE INJURIESMansoor khan
A N A T O M YConnective tissue
(epineurium, perineurium, endoneurium)
Nerve tissue(axon, schwann cell)
A
N
A
T
O
M
Y
EPINEURIUM
PERINEURIUM
ENDONEURIUM
VESSELS
NERVE INJURIES
Acute injury Chronic injury
PERRIPHERAL NERVE INJUIES
N e u r o p r a x i a
Mildest form, reversible conduction block(function loss), for hours or days due to direct mechanical
compression, ischemia, mild burn trauma or stretch
A x o n t m e s i s
N e u r o t m e s i s
C l i n i c a l S i g n s Motor function, Tinel’s sign (positive-sensory function
negative (after 4-6weeks)-total interruption, Sweating-
sympathetic fiber, Sensory function
Muscle atrophy start : post-injury 1 month
peak : 3rd - 4th month
C h r o n i c N e r v e E n t r a p m e n t
Paresthesia
Loss of function
Pain
P a t h o p h y s i o l o g yDirect compression
Segmental demyelination Wallerian degeneration(distal)
Ischemia Swelling of nerve
Microcompartment SD
C a r p a l T u n n e l S y n d r o m e
PREGNANCY
TYPE WRITING
PAIN & PARASTHESIA DISTRIBUSION
RELEASE SURGERY
SUPRA-CONDYLAR FRACTURE anterior displacement
M
E
D
I
A
N
N
E
R
V
E
Radial Nerve Entrapment Posterior Interosseous Nerve Syndrome
Radial Nerve Entrapment Posterior Interosseous Nerve Syndrome
RADIAL NERVE INJURYFracture of shaft of humrus
RADIAL NERVE INJURY
WRIST DROP
GUYON’S CANNAL SYNDROME
U
L
N
A
R
N
E
R
V
E
CUBITAL TUNNEL SYNDROME
U
L
N
A
R
N
E
R
V
E
Benediction postureCLAWING OF RING & LITTLE FINGER
U
L
N
A
R
N
E
R
V
E
FROMENT’S SIGN Flexior pollicus longus (median nerve) compensates for a weak adductor pollicis (ulnar nerve)
U
L
N
A
R
N
E
R
V
E
CUBITAL TUNNEL SYNDROME Ulnar nerve Release surgery
U
L
N
A
R
N
E
R
V
E
COMMON PERONEALFracture of the head of fibula
PERONEAL NERVE INJURY SYMPTOMSDecreased sensation, Slapping gait, foot drop, toes drag
FACIAL NERVE Anatomy
FACIAL NERVE Anatomy
FACIAL NERVE PALSY LOSS OF FRONING, DROOPING, EYEBROW DROP
C o n s e r v a t i v e t r e a t m e n t
IndicationsShort history, mild-moderate, intermittent,
reversible cause (pregnancy, oral contraceptive,endocrine abnormalities, type writer)
MethodNon-steroidal anti-inflammatory drugs, splint
T r e a t m e n t
Time of operation
Open injury Closed injury
Early intervention Delayed intervention Delayed intervention
S u r g i c l I n d i c a t i o
n s
E p i n e u r a l R e p a i r
F a s c i c u l a r R e p a i r
N e r v e G r a f t