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NeuroD.pptx
1. (Khaled Hussein, MSc.PT )
Admin, Founder at Physio ( Facebook PT Education Group)
Founder at AL Safwa PT Clinic
Assistant Lecturer of Neurology, Cairo University
Certified Clinical Nutritionist
Neurodynamics in Practice
2.
3. Endoneurium
Layer of delicate connective tissue surrounding the axon.
It plays an important role in the maintenance of the endoneurial space and
fluid pressure (slightly positive)
Any alteration in the pressure, as may occur with oedema, could interfere
with conduction and movement of the axoplasm (axoplasmic flow).
Endoneurium has a role in protecting the axons from tensile force
(collagen fibril orientation is longitudinal)
Cutaneous nerves have a greater percentage of endoneurium to provide extra
cushioning to nerves (more superficial)
4. Perineurium
Connective tissue wrapping surrounding a nerve fascicle.
Perineurium Protect the contents of the endoneurial tubes,acting as a
mechanical barrier to external forces.
the last connective tissue sheath to rupture in tensile testing.
collagen fibers run parallel, circular and oblique to nerve fibers “protect the nerve
from kinking when it has to go around an acute angle (ulnar nerve at the elbow)”
5. Epineurium
Whole nerve is surrounded by
tough fibrous sheath.
Maintains the course of peripheral
nerve among different structures
Acts as a shield against mechanical
forces
6.
7. spiral bands of Fontana’
With stretch, the
lamellae of the
myelin sheath slide
on each other and
the Schmidt
Lantermann Clefts
(SLC) open up , this
allow considerable
elongation of the
axon
Fascicles run in a
wavy course
throughout the
nerve trunk
This provides
protection from
compression and
tensile forces,
more so than if the
fascicles ran in a
straight line.
Greater number of
fascicles provides
more protection
for nerve from
compressive forces
8.
9. Blood Nerve barrier Mechanism
A slightly positive pressure exists
in the intrafascicular
environment.
This tissue pressure is referred to
as the endoneurial fluid pressure
(EFP) and is probably maintained
by the elasticity of the
perineurium.
As well as protection from the
exterior, this mechanism means
that if the intrafascicular pressure
increases, such as from an
oedematous reaction), the
barrier may close.
A good example of the protective
function of the diffusion barrier is
where peripheral nerves travel
through infected areas without
nerve conduction being altered
.The perineurial barrier is also
resistant to trauma.
10. Nervi Nervorum
Free nerve endings have been
observed in the perineurium,
epineurium and endoneurium
pain from local pressure on a
nerve to be due to the nervi
Nervorum, it seems very likely
that it plays a part in adverse
tension syndromes
it’s regarded as a protective
mechanism for the nervous
system, symptom production
being a warning that the impulse
conducting mechanisms may be
in danger from mechanical or
chemical compromise
The nervi nervorum must be
Considered a source of
symptoms in diabetic neuropathy
and in inflammatory
polyneuropathics.
11. Nerve roots
Although nerve roots are usually described as part of PNS,
they are considered to be more a part of the central because:
They lack Schwann cells
They receive at least half of their nutrition from the
cerebrospinal fluid.
They involve the meninges
12. (Safety mechanisms)
The dural sleeve forms a plugging
mechanism which
stops the nerve roots being pulled out of
the intervertebral foramen
and also a convenient force distributor.
13. Nerve roots inbuilt safety
They lie in undulations and are able to
unfold.
Cerebrospinal fluid (CSF) supplies
approximately half of the nerve root’s
metabolic needs. CSF also cushions and
protects the roots.
Individual fascicles within the nerve root
have the ability to slide on each other as they
do in peripheral nerve.
14. Denticulate ligaments
The Dural sleeves forms a plugging mechanism, stopping the nerve
roots being pulled out of the intervertebral foramen.
Traction is finally transmitted to the cord via the denticulate
ligaments and this partially eased the tension on the nerve roots.
Nerve roots also have their own inbuilt mechanisms (lie in
undulations and are able to unfold)
Nerve roots are surrounded by CSF which cushions and protects
the roots
15.
16.
17.
18. Consequences of nerve injury
0-impaired axoplasmic flow
0-hypersensitive Nervi Nervorum
1-Fibrosis
2-The double crush syndrome
3-Abnormal impulse generating mechanisms
4-Contracture of the nervous system
19. role of Sinuvertebral Nerves in chronic pain
conditions
Dura mater is innervated by segmental, bilateral, sinuvertebral nerves (Meningeal
Branch Of Spinal Nerves )
The posterior longitudinal ligament, -Periosteum, -Blood vessels the annulus
fibrosis, and Connective tissues of the anterior nerve roots.
Root sleeves at cervical and lumbar levels have a richer nerve supply than the
thoracic root sleeves
Irritation of the sinuvertebral nerves is common with Dural dysfunctions, bony defects or
osteoporosis of vertebral bones, spinal ligamentous injuries or hypertrophy , annular and
discogenic conditions , leading to chronic pain and disability especially in cases of cervical
and lumbar spondylosis
