• Trigeminal neuralgia • Bells palsy • Sciatica

1. CONDITIONS OFTHE
PERIPHERAL NERVES
By C Settley

2. The nervous system
• The nervous system is the part of a living organism that
coordinates its actions by transmitting signals to and from
different parts of its body.
• The peripheral nervous system is one of the two
components of the nervous system, the other part is the
central nervous system.
• The PNS consists of the nerves and ganglia outside the brain
and spinal cord.
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4. The peripheral nervous system
• “Peripheral nerve” is a term used synonymously to describe
the peripheral nervous system.
• The peripheral nervous system is a network of 43 pairs of
motor and sensory nerves that connect the brain and spinal
cord (the central nervous system) to the entire human body.
• These nerves control the functions of sensation, movement
and motor coordination.
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5. Spinal cord and spinal nerves. Nerve plexuses (networks) are shown.
(A) Lateral view. (B) Posterior view.
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6. The peripheral nervous system includes
the following nerves:
• Brachial plexus nerve
• This nerve is a network of
nerves that consists of the last
4 cervical nerve roots
(vertebrae C5-C8) and the first
thoracic (vertebraeT1) nerve
root, and ensures motion and
feeling in the upper limbs.
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7. The peripheral nervous system includes
the following nerves:
• Common peroneal nerve (L4, L5, S1
& S2)
• This nerve is a branch of the sciatic
nerve and is made up of the deep and
superficial peroneal branches.
• They provide sensation to the anterior
(front) and lateral (side) parts of the
legs and top of the feet.
• They innervate muscles in the legs that
pull the ankle and toes up (dorsi
flexion).
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8. The peripheral nervous system includes
the following nerves:
• Femoral nerve
• This nerve is a part of the
lumbar plexus.
• The femoral nerve provides
sensation to the anterior
(front) aspect of the thigh.
• It innervates muscles in the
anterior thigh which allow the
knee to extend.
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9. The peripheral nervous system includes
the following nerves:
• Lateral femoral cutaneous
nerve (L2,3)
• This nerve is part of the lumbar
plexus nerve network.
• The lateral femoral cutaneous
nerve provides sensation to the
anterior and lateral sides of the
thigh.
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10. The peripheral nervous system includes
the following nerves:
• Median nerve (C6, C7, C8 &T1.)
• This nerve is a branch of the
medial and lateral cords of the
brachial plexus.
• The median nerve provides
sensation to the thumb, 1st,
2nd, 3rd and half of the 4th
finger. It innervates muscles in
the forearm and hand that
allow pincher grasp (the ability
to grasp an object between the
thumb and forefinger).2018/07/30 Compiled byC Settley 10

11. The peripheral nervous system includes
the following nerves:
• Radial nerve
• This nerve branches from the
posterior (back) cord of the
brachial plexus.
• The radial nerve provides
sensation to a portion of the
skin on the back of the hand.
• It innervates muscles in the
arm that extend the elbow and
muscles in the forearm, which
enables the wrist and fingers to
straighten or extend.
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12. The peripheral nervous system includes
the following nerves:
• Sciatic nerve
• The sciatic nerve is the largest
single nerve in the body,
extending from the back of the
pelvis down the back of the
thigh.
• It is the primary nerve of the
leg and is responsible for
innervating the muscles in the
hip and lower limbs (including
the tibial nerve and common
fibular nerve).
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13. The peripheral nervous system includes
the following nerves:
• Spinal accessory nerve (C5–C6)
• This nerve is part of the cranial
nerve network.
• It is located on the side of the
neck and innervates the
trapezius and sternomastoid
muscle, which control specific
shoulder movements, such as
shrugging and adduction of the
scapula.
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14. The peripheral nervous system includes
the following nerves:
• Tibial nerve (L4-S3 )
• This nerve is a branch of the
sciatic nerve and provides
sensation to the bottom of the
foot.
• It innervates the calf muscles
which allow the foot and toes
to flex (plantar flexion).
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15. The peripheral nervous system includes
the following nerves:
• Ulnar nerve (C8-T1)
• This nerve is a branch of the
medial cord of the brachial
plexus.
• The ulnar nerve provides
sensation to half of the 4th and
the entire 5th finger.
• It innervates muscles in the
forearm and hand that allow
the wrist and finger to flex
(flexion) and fine finger control.
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16. Trigeminal neuralgia
• A chronic pain condition
affecting the trigeminal
nerve in the face.
• Mild stimulation of the face
— such as from brushing
teeth or putting on makeup
— may trigger a jolt of
excruciating pain.
• V cranial nerve
Branches of the trigemninal nerve:
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17. Trigeminal neuralgia
Symptoms
• Episodes of severe, shooting or jabbing pain that may feel like an electric shock
• Spontaneous attacks of pain or attacks triggered by things such as touching the face, chewing, speaking or brushing
teeth
• Bouts of pain lasting from a few seconds to several minutes
• Episodes of several attacks lasting days, weeks, months or longer — some people have periods when they experience no
pain
• Constant aching, burning feeling that may occur before it evolves into the spasm-like pain of trigeminal neuralgia
• Pain in areas supplied by the trigeminal nerve, including the cheek, jaw, teeth, gums, lips, or less often the eye and
forehead
• Pain affecting one side of the face at a time, though may rarely affect both sides of the face
• Pain focused in one spot or spread in a wider pattern
• Attacks that become more frequent and intense over time
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18. Trigeminal neuralgia
Causes
• In trigeminal neuralgia, the trigeminal nerve's function is disrupted.
• Usually, the problem is contact between a normal blood vessel — in this case, an artery or
a vein — and the trigeminal nerve at the base of the brain.
• This contact puts pressure on the nerve and causes it to malfunction.
• Trigeminal neuralgia can occur as a result of aging, or it can be related to multiple sclerosis
or a similar disorder that damages the myelin sheath protecting certain nerves.
• Trigeminal neuralgia can also be caused by a tumor compressing the trigeminal nerve.
• Some people may experience trigeminal neuralgia due to a brain lesion or other
abnormalities.
• In other cases, surgical injuries, stroke or facial trauma may be responsible for trigeminal
neuralgia.
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19. Trigeminal neuralgia
Treatment
• Carbamezapine (According to SA guidelines)
• Oral 100 mg 2-3 times daily, initial dose
• Increase dose slowly
• Doses of up to 1200 mg daily
• Reduce to maintenance dose of 400-800 mg daily
• Surgery
• Rhizotomy
• An electrified hot probe is inserted at the sensory nerve just outside
the joint to disable the nerve and prevent pain signals from reaching
the brain.
• Injection of glycerol into the nerve root
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20. Bell’s palsy
• The person may find that they
suddenly cannot control their
facial muscles, usually on one
side.
• The affected side of the face
tends to droop.
• The weakness may also affect
saliva and tear production, and
the sense of taste.
• Many people are afraid they are
having a stroke, but if the
weakness or paralysis only
affects the face, it is more likely
to be Bell's palsy.
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21. Bell’s palsy
Causes
• The facial nerve controls most of the muscles in the face and parts of the ear.The facial nerve
goes through a narrow gap of bone from the brain to the face. If the facial nerve is inflamed, it
will press against the cheekbone or may pinch in the narrow gap.This can result in damage to
the protective covering of the nerve. If the protective covering of the nerve becomes damaged,
the signals that travel from the brain to the muscles in the face may not be transmitted
properly, leading to weakened or paralyzed facial muscles.This is Bell's palsy.
• It may result when a virus, usually the herpes virus, inflames the nerve.This is the same virus
that causes cold sores and genital herpes.
• Other viruses that have been linked to Bell's palsy include
• chickenpox and shingles virus
• coldsores and genital herpes virus
• Epstein-Barr virus, or EBV, responsible for mononucleosis
• Cytomegalovirus
• mumps virus
• influenza B
• hand-foot-and-mouth disease (coxsackievirus)
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22. Bell’s palsy
Treatment
• Most people will recover
from Bell's palsy in 1-2
months, especially those who
still have some degree of
movement in their facial
muscles.
• Treatment with a hormone
called prednisolone can
speed up recovery.
• Possible side effects of prednisolone:
• abdominal pain, bloating
• acne
• difficulty sleeping
• dry skin
• headache, dizziness (spinning sensation)
• increased appetite
• increased sweating
• indigestion
• mood changes
• nausea
• oral thrush
• slow wound healing
• thinning skin
• tiredness
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23. Sciatica
• Pain radiating along the sciatic nerve, which runs down one or both legs from the
lower back.
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24. Sciatica
Symptoms
• Pain that radiates from the lower (lumbar) spine to the buttock and down the back of the
leg is the hallmark of sciatica.
• The patient might feel the discomfort almost anywhere along the nerve pathway, but it's
especially likely to follow a path from the lower back to the buttock and the back of your
thigh and calf.
• The pain can vary widely, from a mild ache to a sharp, burning sensation or excruciating
pain.
• Sometimes it can feel like a jolt or electric shock.
• It can be worse when coughing or sneezing, and prolonged sitting can aggravate
symptoms.
• Usually only one side of the body is affected.
• Some people also have numbness, tingling or muscle weakness in the affected leg or foot.
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25. Sciatica
Causes
• Sciatica occurs when the sciatic nerve
becomes pinched, usually by a
herniated disk in the spine or by an
overgrowth of bone (bone spur) on
the vertebrae.
• More rarely, the nerve can be
compressed by a tumour or damaged
by a disease.
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26. Sciatica
Risk factors
• Age. Age-related changes in the spine, such as herniated disks and bone spurs, are
the most common causes of sciatica.
• Obesity. By increasing the stress on the spine, excess body weight can contribute
to the spinal changes that trigger sciatica.
• Occupation. A job that requires you to twist your back, carry heavy loads or drive
a motor vehicle for long periods might play a role in sciatica.
• Prolonged sitting. People who sit for prolonged periods or have a sedentary
lifestyle are more likely to develop sciatica than active people are.
• Diabetes. This condition, which affects the way the body uses blood sugar,
increases the risk of nerve damage.
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27. Sciatica
Diagnosis
• X-ray. An X-ray of the spine may reveal an overgrowth of bone (bone spur) that
may be pressing on a nerve.
• MRI. This procedure uses a powerful magnet and radio waves to produce cross-
sectional images of the back. An MRI produces detailed images of bone and soft
tissues such as herniated disks.
• CT scan. When a CT is used to image the spine.
• Electromyography (EMG). This test measures the electrical impulses produced by
the nerves and the responses of muscles.This test can confirm nerve compression
caused by herniated disks or narrowing of the spinal canal (spinal stenosis).
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28. Sciatica
Treatment
• Medications
• Anti-inflammatories
• Muscle relaxants
• Narcotics
• Tricyclic antidepressants
• Anti-seizure medications
• Physical therapy
• Acupuncture
• Chiropractic
• Steroid injections
• Surgery
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29. Sciatica
Lifestyle & home remedies
• Cold packs.
• Hot packs.
• Stretching.
• Over-the-counter medications.
• Pain relievers such as ibuprofen (Advil, Motrin IB, others)
and naproxen sodium (Aleve) are sometimes helpful for
sciatica.
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30. Sciatica
Complications
• Although most people recover fully from sciatica, often
without treatment, sciatica can potentially cause permanent
nerve damage.
• Loss of feeling in the affected leg
• Weakness in the affected leg
• Loss of bowel or bladder function
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31. Sciatica
Prevention
• Exercise regularly. To keep the back strong, pay special attention to the core
muscles — the muscles in the abdomen and lower back that are essential for
proper posture and alignment.
• Maintain proper posture when sitting. Choose a seat with good lower back
support, armrests and a swivel base. Consider placing a pillow or rolled towel
in the small of the back to maintain its normal curve. Keep the knees and hips
level.
• Use good body mechanics. If standing for long periods, rest one foot on a
stool or small box from time to time.When lifting something heavy, let the
lower extremities do the work. Move straight up and down. Keep the back
straight and bend only at the knees. Hold the load close to the body. Avoid
lifting and twisting simultaneously. Find a lifting partner if the object is heavy
or awkward.
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32. Sciatica
When to see the doctor
• Mild sciatica usually goes away over time.
• If self care measures fail to ease the symptoms or the pain last longer than a week
then the patient should seek medical attention.
• Sudden, severe pain in the lower back or leg and numbness or muscle weakness in
the leg.
• The pain follows a violent injury, such as a traffic accident.
• Trouble controlling your bowels or bladder.
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33. Reference list
• http://encyclopedia.lubopitko-bg.com/The_Spinal_Nerves.html
• http://www.clinicalexams.co.uk/femoral-nerve-lesions/
• https://neckandback.com/conditions/meralgia-paresthetica-lateral-femoral-
cutaneous-nerve-entrapment/
• http://www.clinicalexams.co.uk/median-nerve-lesions/
• https://www.spine-health.com/glossary/rhizotomy
• https://www.mayoclinic.org/diseases-conditions/sciatica/symptoms-causes/syc-
20377435
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