peripheral nerve lesions

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peripheral nerve lesions

  1. 1. PERIPHERAL NERVE INJURIES Dr. Mansoor Khan, MBBS, FCPS I, Resident Surgery, KTH, Peshawar
  2. 2. A N A T O M Y Connective tissue (epineurium, perineurium, endoneurium) Nerve tissue (axon, schwann cell)
  3. 4. A N A T O M Y EPINEURIUM PERINEURIUM ENDONEURIUM VESSELS
  4. 5. PERRIPHERAL NERVE INJUIES NERVE INJURIES Acute injury Chronic injury
  5. 6. 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
  6. 7. A x o n t m e s i s Axonal and myelin sheath disruption while fascicular integrity is maintained--Wallerian degeneration occurs (prognosis is good—days, weeks)
  7. 8. N e u r o t m e s i s Laceration from sharp or blunt forces causing complete disruption of the axon and supporting connective tissue---very poor prognosis without surgical repair
  8. 11. 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
  9. 12. Muscle atrophy start : post-injury 1 month peak : 3rd - 4th month
  10. 13. 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
  11. 14. P a t h o p h y s i o l o g y Direct compression Segmental demyelination Wallerian degeneration(distal) Ischemia Swelling of nerve Microcompartment SD
  12. 16. C a r p a l T u n n e l S y n d r o m e
  13. 17. PREGNANCY TYPE WRITING
  14. 18. PAIN & PARASTHESIA DISTRIBUSION
  15. 19. RELEASE SURGERY
  16. 21. SUPRA-CONDYLAR FRACTURE anterior displacement M E D I A N N E R V E
  17. 22. Radial Nerve Entrapment Posterior Interosseous Nerve Syndrome
  18. 23. Radial Nerve Entrapment Posterior Interosseous Nerve Syndrome
  19. 24. RADIAL NERVE INJURY Fracture of shaft of humrus
  20. 25. RADIAL NERVE INJURY WRIST DROP
  21. 26. GUYON’S CANNAL SYNDROME U L N A R N E R V E
  22. 27. CUBITAL TUNNEL SYNDROME U L N A R N E R V E
  23. 28. CUBITAL TUNNEL SYNDROME U L N A R N E R V E
  24. 29. Benediction posture CLAWING OF RING & LITTLE FINGER U L N A R N E R V E
  25. 30. 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
  26. 31. CUBITAL TUNNEL SYNDROME Ulnar nerve Release surgery U L N A R N E R V E
  27. 32. COMMON PERONEAL Fracture of the head of fibula
  28. 33. PERONEAL NERVE INJURY SYMPTOMS Decreased sensation, Slapping gait, foot drop, toes drag
  29. 34. FACIAL NERVE Anatomy
  30. 35. FACIAL NERVE Anatomy
  31. 36. FACIAL NERVE PALSY LOSS OF FRONING, DROOPING, EYEBROW DROP
  32. 37. C o n s e r v a t i v e t r e a t m e n t Indications Short history, mild-moderate, intermittent, reversible cause (pregnancy, oral contraceptive, endocrine abnormalities, type writer) Method Non-steroidal anti-inflammatory drugs, splint
  33. 38. T r e a t m e n t Time of operation Open injury Closed injury Early intervention Delayed intervention Delayed intervention
  34. 39. S u r g i c a l I n d i c a t i o n s Failed conservative treatment Severe injury (sensory loss, muscle atrophy, motor weakness)
  35. 40. E p i n e u r a l R e p a i r
  36. 41. F a s c i c u l a r R e p a i r
  37. 42. N e r v e G r a f t

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