Axonal regeneration occurs by formation of the new axonal processes
which grow at a speed of 1-2 mm per t
Neurotmesis Division of the nerve trunk Occurs in open wounds Neural tubes are destroyed A Neuroma is formed( regenerating fibers + Schwann cells + fibroblasts) Function may be adequate but is never normal even after surgical repair.
Diagnosis Symptoms : (1) Numbness (2) Tingling (3) Weakness Signs: (1) Abnormal posture ( wrist drop) (2) Atrophy of the muscles (3) Change in sensibility Tinels sign : shows progression in nerve recovery Electrodiagnostic tests (1) level of injury (2) Severity (3) progress of nerve recovery
Klumpke’s palsy: Less common The arm is flail and pale All muscles of the fingers are paralyzed ± Ipsilateral Horner’s syndrome
Treatment: If there is no biceps recovery by 3 months, surgery is performed: If the roots are not avulsed: Nerve graft If the roots are avulsed : Nerve transfer If severe internal rotation : Subscapularis release ± tendon transfer OR Rotation osteotomy of the humerus Physiotherapy in all cases Prognosis in Klumpke’s palsy is poor.
Axillary nerve injury (C5) Supplies (1) Deltoid (2) Skin over the lower ½ of the deltoid. Injured in (1) Shoulder dislocation (2) # of humeral neck Clinically (1) Loss of abduction (2) Numbness over the deltoid.