Your SlideShare is downloading. ×
orthopedics,peripheral nerve injury.(dr.baxtiar rasul)
orthopedics,peripheral nerve injury.(dr.baxtiar rasul)
orthopedics,peripheral nerve injury.(dr.baxtiar rasul)
orthopedics,peripheral nerve injury.(dr.baxtiar rasul)
orthopedics,peripheral nerve injury.(dr.baxtiar rasul)
orthopedics,peripheral nerve injury.(dr.baxtiar rasul)
orthopedics,peripheral nerve injury.(dr.baxtiar rasul)
orthopedics,peripheral nerve injury.(dr.baxtiar rasul)
orthopedics,peripheral nerve injury.(dr.baxtiar rasul)
orthopedics,peripheral nerve injury.(dr.baxtiar rasul)
orthopedics,peripheral nerve injury.(dr.baxtiar rasul)
orthopedics,peripheral nerve injury.(dr.baxtiar rasul)
orthopedics,peripheral nerve injury.(dr.baxtiar rasul)
orthopedics,peripheral nerve injury.(dr.baxtiar rasul)
orthopedics,peripheral nerve injury.(dr.baxtiar rasul)
orthopedics,peripheral nerve injury.(dr.baxtiar rasul)
orthopedics,peripheral nerve injury.(dr.baxtiar rasul)
orthopedics,peripheral nerve injury.(dr.baxtiar rasul)
orthopedics,peripheral nerve injury.(dr.baxtiar rasul)
orthopedics,peripheral nerve injury.(dr.baxtiar rasul)
orthopedics,peripheral nerve injury.(dr.baxtiar rasul)
Upcoming SlideShare
Loading in...5
×

Thanks for flagging this SlideShare!

Oops! An error has occurred.

×
Saving this for later? Get the SlideShare app to save on your phone or tablet. Read anywhere, anytime – even offline.
Text the download link to your phone
Standard text messaging rates apply

orthopedics,peripheral nerve injury.(dr.baxtiar rasul)

2,319

Published on

Published in: Health & Medicine
0 Comments
5 Likes
Statistics
Notes
  • Be the first to comment

No Downloads
Views
Total Views
2,319
On Slideshare
0
From Embeds
0
Number of Embeds
0
Actions
Shares
0
Downloads
204
Comments
0
Likes
5
Embeds 0
No embeds

Report content
Flagged as inappropriate Flag as inappropriate
Flag as inappropriate

Select your reason for flagging this presentation as inappropriate.

Cancel
No notes for slide

Transcript

  • 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. .

×