orthopedics,peripheral nerve injury.(dr.baxtiar rasul)
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  • 1. Peripheral nerve injuries
  • 2. Structure of the nerve Axon myeline sheath Schwann cell layer Endoneurium Perineurium Epineurium
  • 3. Pathology The nerve is injured by: Ischaemia Compression Traction Laceration burning
  • 4.
    • Types of injury
    • Transient ischaemia
    • Neurapraxia
    • Axonotmesis
    • Neurotmesis
  • 5. Transient ischaemia Acute nerve compression -> Acute endoneural anoxia -> Temporary numbness + muscle wasting Recovery by 10 minutes
  • 6. Neurapraxia Chronic mechanical pressure -> Demyelination of axon Spontaneous recovery after few days or weeks
  • 7.
    • Axonotmesis
    • Segmental interruption of the axons
    • Loss of conduction
    • But the neural tubes are intact
    • Seen in closed fractures and dislocations
    • Distal to the lesion -> Wallerian degeneration
    • Axonal regeneration occurs by formation of the new axonal processes
    • which grow at a speed of 1-2 mm per t
  • 8. 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.
  • 9. 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
  • 10.
    • Obstetric brachial plexus injuries
    • Caused by excessive traction on the brachial plexus during childbirth
    • .
    • C5+C6+C7+C8+T1
    • Clinical features :
    • Difficult delivery
    • Flail arm.
    • Further examination reveals one of the following:
    • (A) Erb’s palsy
    • (B) klumpke’s palsy
  • 11.  
  • 12. Erb’s palsy: Injury of C5+ C6 The arm is held to the side, internally rotated, and pronated. (i.e paralysis of the abductors and external rotators of the shoulder + the supinators)
  • 13.  
  • 14.  
  • 15. Klumpke’s palsy: Less common The arm is flail and pale All muscles of the fingers are paralyzed ± Ipsilateral Horner’s syndrome
  • 16. 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.
  • 17.  
  • 18. 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.
  • 19.  
  • 20.  
  • 21. Treatment: Spontaneous recovery during 8 weeks. If not: Exploration + repair OR graft. If failed: Tendon transfer OR Shoulder arthrodesis. .