The document provides information about the radial nerve including its anatomy, course, branches and clinical presentations of radial nerve palsies. It discusses the radial nerve's origin from the brachial plexus and branches in the arm and forearm. Common causes of radial nerve palsy include fractures and entrapment in the radial tunnel. Clinical features, investigations, treatment including splinting and tendon transfers, and postoperative management are outlined. Surgical techniques for nerve repair and reconstructive procedures are also described.
This document discusses radial nerve injury, including its anatomy, causes, clinical presentation, diagnostic workup, and management. It describes the radial nerve's course from the brachial plexus into the arm and forearm. Radial nerve injuries can be caused by fractures, compression, or traction injuries. Clinical examination involves assessing motor function of wrist and finger extensors and sensory function on the back of the hand. Management includes nonsurgical treatment, nerve repair or grafting, and tendon transfers in chronic cases. The goal of treatment is to restore wrist and finger extension through nerve regeneration or reconstruction of function.
The document provides information about ulnar nerve injury, including its course through the upper limb, branches and sensory/motor supply. Causes of injury include compression at sites like the elbow (cubital tunnel syndrome) and wrist (Guyon's canal syndrome). Signs and symptoms involve sensory loss and weakness of hand muscles. Clinical tests assess functions like pinching. Investigations include EMG, nerve conduction studies and imaging. Claw hand deformity can occur with severe ulnar nerve injury.
This document provides information about Perthes' disease, including:
- It is characterized by avascular necrosis of the femoral head in children.
- Risk factors include being male and between ages 5-10 years old.
- Imaging studies like x-rays are used to diagnose and monitor the stages of avascular necrosis, fragmentation, ossification, and remodeling.
- Differential diagnosis depends on whether the condition is unilateral or bilateral.
- Treatment aims to prevent deformity through nonsurgical or surgical methods depending on the severity.
This document provides an overview of clubfoot (congenital talipes equinovarus), including:
1. The definition, incidence, causes, and typical deformities seen in clubfoot.
2. Evaluation methods like the Pirani scoring system and radiographic assessment.
3. Treatment approaches like the Ponseti method of serial casting and bracing, as well as surgical options like the McKay procedure when non-operative treatment fails.
4. Post-operative casting protocols and complications that can arise from treatment.
Dr. Ankur Mittal's presentation discusses stenosing tenosynovitis, also known as trigger finger. The anatomy of the flexor tendon sheath and pulley system is described. Trigger finger occurs when a thickened flexor tendon catches on the A1 pulley, most commonly in the ring finger. Conservative treatments include splinting, steroid injections, and exercises, while surgery involves open or percutaneous release of the A1 pulley. Postoperative care focuses on early mobilization while avoiding complications like nerve damage or bowstringing. Surgical synovectomy may be required in rheumatoid patients to address underlying synovitis.
De Quervain's tenosynovitis is an inflammation of the tendon sheaths of the abductor pollicis longus and extensor pollicis brevis muscles in the wrist. It commonly affects women ages 30-50 and is caused by repetitive motions like knitting or computer use that strain the thumb and wrist. Symptoms include pain on the radial side of the wrist worsened by thumb movement. Conservative treatment involves splinting, anti-inflammatories, corticosteroid injections, and physical therapy exercises. Surgery may be considered if symptoms persist after several weeks of conservative care.
This document discusses radial nerve injury, including its anatomy, causes, clinical presentation, diagnostic workup, and management. It describes the radial nerve's course from the brachial plexus into the arm and forearm. Radial nerve injuries can be caused by fractures, compression, or traction injuries. Clinical examination involves assessing motor function of wrist and finger extensors and sensory function on the back of the hand. Management includes nonsurgical treatment, nerve repair or grafting, and tendon transfers in chronic cases. The goal of treatment is to restore wrist and finger extension through nerve regeneration or reconstruction of function.
The document provides information about ulnar nerve injury, including its course through the upper limb, branches and sensory/motor supply. Causes of injury include compression at sites like the elbow (cubital tunnel syndrome) and wrist (Guyon's canal syndrome). Signs and symptoms involve sensory loss and weakness of hand muscles. Clinical tests assess functions like pinching. Investigations include EMG, nerve conduction studies and imaging. Claw hand deformity can occur with severe ulnar nerve injury.
This document provides information about Perthes' disease, including:
- It is characterized by avascular necrosis of the femoral head in children.
- Risk factors include being male and between ages 5-10 years old.
- Imaging studies like x-rays are used to diagnose and monitor the stages of avascular necrosis, fragmentation, ossification, and remodeling.
- Differential diagnosis depends on whether the condition is unilateral or bilateral.
- Treatment aims to prevent deformity through nonsurgical or surgical methods depending on the severity.
This document provides an overview of clubfoot (congenital talipes equinovarus), including:
1. The definition, incidence, causes, and typical deformities seen in clubfoot.
2. Evaluation methods like the Pirani scoring system and radiographic assessment.
3. Treatment approaches like the Ponseti method of serial casting and bracing, as well as surgical options like the McKay procedure when non-operative treatment fails.
4. Post-operative casting protocols and complications that can arise from treatment.
Dr. Ankur Mittal's presentation discusses stenosing tenosynovitis, also known as trigger finger. The anatomy of the flexor tendon sheath and pulley system is described. Trigger finger occurs when a thickened flexor tendon catches on the A1 pulley, most commonly in the ring finger. Conservative treatments include splinting, steroid injections, and exercises, while surgery involves open or percutaneous release of the A1 pulley. Postoperative care focuses on early mobilization while avoiding complications like nerve damage or bowstringing. Surgical synovectomy may be required in rheumatoid patients to address underlying synovitis.
De Quervain's tenosynovitis is an inflammation of the tendon sheaths of the abductor pollicis longus and extensor pollicis brevis muscles in the wrist. It commonly affects women ages 30-50 and is caused by repetitive motions like knitting or computer use that strain the thumb and wrist. Symptoms include pain on the radial side of the wrist worsened by thumb movement. Conservative treatment involves splinting, anti-inflammatories, corticosteroid injections, and physical therapy exercises. Surgery may be considered if symptoms persist after several weeks of conservative care.
This document discusses median nerve injuries, including:
- The anatomy and functions of the median nerve in the forearm and hand.
- Clinical assessment of median nerve function through specific muscle tests.
- Common median nerve compression syndromes like carpal tunnel syndrome.
- Classification of nerve injuries and management options for median nerve injuries.
Peripheral nerve injuries can occur through various mechanisms and be classified in different ways. The median, radial, and ulnar nerves are commonly injured in the upper limb. Examination of specific muscles innervated by each nerve helps to localize the level and severity of injury. Precise history taking and clinical assessment including motor, sensory and trophic changes are needed to diagnose peripheral nerve lesions.
This document discusses congenital talipes equino-varus (CTEV), also known as clubfoot. CTEV is a congenital deformity of the foot and ankle characterized by equinus, inversion, adduction and cavus. It occurs in about 1 in 1000 live births. The document describes the types and causes of CTEV, pathological changes, treatment methods including Ponseti technique and surgery, and long-term management with bracing. Non-operative treatment is usually attempted first using serial casting and manipulation techniques.
Shoulder impingement syndrome occurs when the tendons of the rotator cuff muscles become irritated and inflamed as they pass through the subacromial space under the coraco-acromial arch. It results in pain, weakness, and loss of movement, especially in an arc between 45-160 degrees of shoulder abduction and elevation. Causes include repeated overhead arm use, trauma, poor posture, and degenerative changes. Clinical features are pain at rest or with movement, and limited range of motion. Diagnosis involves x-rays and MRI, while special tests like Neer's and Hawkins' tests reproduce shoulder pain. Treatment consists of rest, anti-inflammatories, physical therapy including stretching,
This document provides an overview of median nerve injuries, including anatomy, types of injuries, clinical examination findings, and management principles. It describes the anatomy of the median nerve from its origins in the brachial plexus through the arm, forearm, and hand. It discusses high and low median nerve injuries. Key examination techniques are outlined, including tests for specific muscle function. Surgical management principles include nerve repair, decompression, and tendon transfers. Common compression neuropathies like carpal tunnel syndrome and pronator teres syndrome are also summarized, including their symptoms, diagnosis, and treatment.
Foot drop is the inability to lift the front part of the foot. It can be caused by injuries or conditions that damage the common peroneal nerve. Symptoms include difficulty lifting the foot and dragging the toes. Treatment depends on the underlying cause but may include bracing, nerve stimulation, tendon transfers, or joint fusions. The goal is to improve mobility and gait.
This document discusses foot drop, which is the inability to lift the front part of the foot. It can be caused by nerve injuries, neurological conditions, muscle weakness, or injuries. Symptoms include difficulty lifting the foot and dragging it when walking. Treatment depends on the underlying cause but may include bracing, physical therapy, nerve stimulation, or surgery to repair nerves or transfer tendons.
This document discusses supracondylar fractures of the humerus, which occur most commonly in children ages 5-10 years old. It describes the anatomy of the elbow joint and mechanisms of injury for supracondylar fractures. The Gartland classification system grades the fractures from non-displaced to severely displaced. Treatment depends on the fracture type, with non-displaced fractures treated conservatively and displaced fractures requiring closed or open reduction with pin fixation. Complications can include vascular injury, nerve injury, compartment syndrome, malunion, and elbow stiffness.
Galeazzi fracture-dislocation is a fracture of the distal or middle third of the radius shaft combined with dislocation of the distal radioulnar joint. It most often occurs in males due to indirect trauma from a fall on an outstretched hand with rotation. Radiographs show the radial fracture and dislocation of the distal radioulnar joint. Treatment involves open reduction and internal fixation of the radial fracture with a plate while restoring length and stability of the distal radioulnar joint. The forearm is then immobilized in supination for 4-6 weeks to heal.
This document discusses radial nerve palsy, which is an injury to the radial nerve resulting in impaired nerve function and causing wrist drop. Wrist drop is the characteristic clinical sign where the wrist hangs flaccidly and cannot be extended. Causes of radial nerve palsy include sleeping with one's arm compressed (e.g. Saturday night palsy from falling asleep with one's arm on a chair or bar), compression from walking with a crutch (crutch palsy), or from another person sleeping on one's arm (honeymoon palsy). Radial nerve palsy results in weakness of wrist and finger extension and grip. Treatment involves reducing pain, increasing range of motion, and restoring
The document provides information on anterior cruciate ligament (ACL) injuries, including:
1. The ACL originates from the femur and inserts into the tibia, resisting anterior tibial translation and medial rotation. ACL injuries most commonly result from rapid changes in direction during sports.
2. Physical examination of ACL injuries involves tests like the Lachman test and anterior drawer test to assess knee stability. MRI is also used for diagnosis.
3. Treatment involves RICE initially, followed by either nonsurgical rehabilitation with bracing or surgical reconstruction using grafts like the patellar tendon. Reconstruction aims to restore stability and function to prevent further knee damage.
Plantar fasciitis is an inflammation of the plantar fascia in the foot that causes heel pain. It is caused by overuse from activities like long-distance running or tight calf muscles limiting the foot's range of motion. Symptoms include pain, swelling, and warmth in the heel area. Conservative treatments include stretching exercises, orthotics, night splints, taping, and manual therapies to increase flexibility and support the arch. Treatment may last several months to two years and surgery is an option for severe cases that do not improve.
Tuberculosis of the hip is caused by Mycobacterium tuberculosis infection. It typically affects people aged 20-30 years old. The infection spreads hematogenously from a primary focus and causes destruction of bone and joints over several years. Clinical features include limping, decreased range of motion, and deformities in advanced cases. Imaging shows osteopenia, joint space narrowing, and bone erosion. Treatment involves chemotherapy for at least 6-9 months along with local measures like joint aspiration and traction. Surgery may be needed for debridement, arthrodesis, or arthroplasty in advanced cases.
Carpal tunnel syndrome involves pressure on the median nerve as it passes through the carpal tunnel in the wrist. Common symptoms include numbness, tingling, and weakness in the hand and fingers. The cause is often unknown but may involve repetitive wrist motions, swelling from conditions like arthritis or pregnancy, or certain anatomical factors. Diagnosis involves physical exams like Tinel's sign and Phalen's maneuver as well as nerve conduction studies or EMG tests. Treatment ranges from splinting, anti-inflammatory drugs, corticosteroid injections, surgery to release pressure on the nerve. Rehabilitation after surgery focuses on scar tissue massage, modalities to reduce pain and swelling, and exercises to strengthen the hand muscles and improve function.
This document provides an overview of scoliosis, including:
- Definitions and classifications of scoliosis types like idiopathic, congenital, neuromuscular, etc.
- Descriptions of curve patterns, measurements, and radiographic assessments.
- Clinical features and evaluations like trunk examination, scoliometer use, and Adams forward bend test.
- Etiology, progression risks, and long-term effects of different scoliosis types.
- Common curve classifications including King's type and Cobb angle measurement method.
It serves as a reference for the clinical presentation, evaluation, and management considerations for different scoliosis conditions.
Waddling gait- definition|role of muscle|gait analysis|kinematic and spatiote...jasna ok
This document discusses waddling gait, which is an abnormal gait pattern seen when there is bilateral weakness of the gluteus medius muscles, the primary hip abductors. During walking, individuals with waddling gait are unable to stabilize the pelvis and it drops on both sides, causing the trunk to laterally bend and the person to walk with a wide base like a duck. Treatment focuses on strengthening exercises for the hip abductors and gluteal muscles, gait training, and balance exercises. Physiotherapy aims to improve muscle strength, correct posture, and retrain a normal walking pattern.
Dr. Mahak Jain presented on spondylolisthesis. Key points include:
1) Spondylolisthesis is the forward translation of one vertebra on another, commonly caused by defects in the pars interarticularis known as spondylolysis.
2) It is classified based on etiology, with dysplastic, isthmic, degenerative, traumatic, and pathological types.
3) Treatment depends on factors like grade, symptoms, and etiology, ranging from conservative care to surgical options like decompression, fusion, and instrumentation.
4) Studies show surgery with fusion has better outcomes for pain and function than nonsurgical treatment or decompression alone for degenerative
Pp for lumbarization and sacralization by Dr Dhruv Taneja Assistant ProfessorDhruv Taneja
Lumbarization is a condition where the first sacral vertebra appears like a lumbar vertebra rather than being fused with the sacrum. This occurs when the first and second sacral segments fail to fuse during development. A lumbarized S1 vertebra may have its own disc or an underdeveloped disc space, making it difficult to accommodate and more prone to injury with age. Sacralization is a related condition where the fifth lumbar vertebra fuses with the sacrum, reducing mobility and increasing stress on the L4 vertebra. Both conditions can potentially lead to back pain and disc problems.
The document provides information on normal EEG wave patterns. It discusses the different wave types (delta, theta, alpha, beta), their typical frequencies, amplitudes, and locations. It also summarizes the normal EEG patterns seen in wakefulness, drowsiness, different sleep stages, and across age groups from newborns to older adults. Key aspects like alpha rhythm, sleep spindles, vertex waves, and age-related changes are outlined.
The radial nerve arises from the posterior cord of the brachial plexus and passes posterior to the axillary artery between the triceps muscle heads. It lies in the spiral groove on the humerus and pierces the lateral intermuscular septum to run between the brachialis and brachioradialis muscles. At the lateral epicondyle, the radial nerve divides into the posterior interosseous nerve and superficial radial nerve. The radial nerve supplies all the extensor muscles of the forearm and arm, and the brachioradialis muscle. Damage to the radial nerve in the spiral groove causes wrist drop but spares elbow extension.
This document discusses median nerve injuries, including:
- The anatomy and functions of the median nerve in the forearm and hand.
- Clinical assessment of median nerve function through specific muscle tests.
- Common median nerve compression syndromes like carpal tunnel syndrome.
- Classification of nerve injuries and management options for median nerve injuries.
Peripheral nerve injuries can occur through various mechanisms and be classified in different ways. The median, radial, and ulnar nerves are commonly injured in the upper limb. Examination of specific muscles innervated by each nerve helps to localize the level and severity of injury. Precise history taking and clinical assessment including motor, sensory and trophic changes are needed to diagnose peripheral nerve lesions.
This document discusses congenital talipes equino-varus (CTEV), also known as clubfoot. CTEV is a congenital deformity of the foot and ankle characterized by equinus, inversion, adduction and cavus. It occurs in about 1 in 1000 live births. The document describes the types and causes of CTEV, pathological changes, treatment methods including Ponseti technique and surgery, and long-term management with bracing. Non-operative treatment is usually attempted first using serial casting and manipulation techniques.
Shoulder impingement syndrome occurs when the tendons of the rotator cuff muscles become irritated and inflamed as they pass through the subacromial space under the coraco-acromial arch. It results in pain, weakness, and loss of movement, especially in an arc between 45-160 degrees of shoulder abduction and elevation. Causes include repeated overhead arm use, trauma, poor posture, and degenerative changes. Clinical features are pain at rest or with movement, and limited range of motion. Diagnosis involves x-rays and MRI, while special tests like Neer's and Hawkins' tests reproduce shoulder pain. Treatment consists of rest, anti-inflammatories, physical therapy including stretching,
This document provides an overview of median nerve injuries, including anatomy, types of injuries, clinical examination findings, and management principles. It describes the anatomy of the median nerve from its origins in the brachial plexus through the arm, forearm, and hand. It discusses high and low median nerve injuries. Key examination techniques are outlined, including tests for specific muscle function. Surgical management principles include nerve repair, decompression, and tendon transfers. Common compression neuropathies like carpal tunnel syndrome and pronator teres syndrome are also summarized, including their symptoms, diagnosis, and treatment.
Foot drop is the inability to lift the front part of the foot. It can be caused by injuries or conditions that damage the common peroneal nerve. Symptoms include difficulty lifting the foot and dragging the toes. Treatment depends on the underlying cause but may include bracing, nerve stimulation, tendon transfers, or joint fusions. The goal is to improve mobility and gait.
This document discusses foot drop, which is the inability to lift the front part of the foot. It can be caused by nerve injuries, neurological conditions, muscle weakness, or injuries. Symptoms include difficulty lifting the foot and dragging it when walking. Treatment depends on the underlying cause but may include bracing, physical therapy, nerve stimulation, or surgery to repair nerves or transfer tendons.
This document discusses supracondylar fractures of the humerus, which occur most commonly in children ages 5-10 years old. It describes the anatomy of the elbow joint and mechanisms of injury for supracondylar fractures. The Gartland classification system grades the fractures from non-displaced to severely displaced. Treatment depends on the fracture type, with non-displaced fractures treated conservatively and displaced fractures requiring closed or open reduction with pin fixation. Complications can include vascular injury, nerve injury, compartment syndrome, malunion, and elbow stiffness.
Galeazzi fracture-dislocation is a fracture of the distal or middle third of the radius shaft combined with dislocation of the distal radioulnar joint. It most often occurs in males due to indirect trauma from a fall on an outstretched hand with rotation. Radiographs show the radial fracture and dislocation of the distal radioulnar joint. Treatment involves open reduction and internal fixation of the radial fracture with a plate while restoring length and stability of the distal radioulnar joint. The forearm is then immobilized in supination for 4-6 weeks to heal.
This document discusses radial nerve palsy, which is an injury to the radial nerve resulting in impaired nerve function and causing wrist drop. Wrist drop is the characteristic clinical sign where the wrist hangs flaccidly and cannot be extended. Causes of radial nerve palsy include sleeping with one's arm compressed (e.g. Saturday night palsy from falling asleep with one's arm on a chair or bar), compression from walking with a crutch (crutch palsy), or from another person sleeping on one's arm (honeymoon palsy). Radial nerve palsy results in weakness of wrist and finger extension and grip. Treatment involves reducing pain, increasing range of motion, and restoring
The document provides information on anterior cruciate ligament (ACL) injuries, including:
1. The ACL originates from the femur and inserts into the tibia, resisting anterior tibial translation and medial rotation. ACL injuries most commonly result from rapid changes in direction during sports.
2. Physical examination of ACL injuries involves tests like the Lachman test and anterior drawer test to assess knee stability. MRI is also used for diagnosis.
3. Treatment involves RICE initially, followed by either nonsurgical rehabilitation with bracing or surgical reconstruction using grafts like the patellar tendon. Reconstruction aims to restore stability and function to prevent further knee damage.
Plantar fasciitis is an inflammation of the plantar fascia in the foot that causes heel pain. It is caused by overuse from activities like long-distance running or tight calf muscles limiting the foot's range of motion. Symptoms include pain, swelling, and warmth in the heel area. Conservative treatments include stretching exercises, orthotics, night splints, taping, and manual therapies to increase flexibility and support the arch. Treatment may last several months to two years and surgery is an option for severe cases that do not improve.
Tuberculosis of the hip is caused by Mycobacterium tuberculosis infection. It typically affects people aged 20-30 years old. The infection spreads hematogenously from a primary focus and causes destruction of bone and joints over several years. Clinical features include limping, decreased range of motion, and deformities in advanced cases. Imaging shows osteopenia, joint space narrowing, and bone erosion. Treatment involves chemotherapy for at least 6-9 months along with local measures like joint aspiration and traction. Surgery may be needed for debridement, arthrodesis, or arthroplasty in advanced cases.
Carpal tunnel syndrome involves pressure on the median nerve as it passes through the carpal tunnel in the wrist. Common symptoms include numbness, tingling, and weakness in the hand and fingers. The cause is often unknown but may involve repetitive wrist motions, swelling from conditions like arthritis or pregnancy, or certain anatomical factors. Diagnosis involves physical exams like Tinel's sign and Phalen's maneuver as well as nerve conduction studies or EMG tests. Treatment ranges from splinting, anti-inflammatory drugs, corticosteroid injections, surgery to release pressure on the nerve. Rehabilitation after surgery focuses on scar tissue massage, modalities to reduce pain and swelling, and exercises to strengthen the hand muscles and improve function.
This document provides an overview of scoliosis, including:
- Definitions and classifications of scoliosis types like idiopathic, congenital, neuromuscular, etc.
- Descriptions of curve patterns, measurements, and radiographic assessments.
- Clinical features and evaluations like trunk examination, scoliometer use, and Adams forward bend test.
- Etiology, progression risks, and long-term effects of different scoliosis types.
- Common curve classifications including King's type and Cobb angle measurement method.
It serves as a reference for the clinical presentation, evaluation, and management considerations for different scoliosis conditions.
Waddling gait- definition|role of muscle|gait analysis|kinematic and spatiote...jasna ok
This document discusses waddling gait, which is an abnormal gait pattern seen when there is bilateral weakness of the gluteus medius muscles, the primary hip abductors. During walking, individuals with waddling gait are unable to stabilize the pelvis and it drops on both sides, causing the trunk to laterally bend and the person to walk with a wide base like a duck. Treatment focuses on strengthening exercises for the hip abductors and gluteal muscles, gait training, and balance exercises. Physiotherapy aims to improve muscle strength, correct posture, and retrain a normal walking pattern.
Dr. Mahak Jain presented on spondylolisthesis. Key points include:
1) Spondylolisthesis is the forward translation of one vertebra on another, commonly caused by defects in the pars interarticularis known as spondylolysis.
2) It is classified based on etiology, with dysplastic, isthmic, degenerative, traumatic, and pathological types.
3) Treatment depends on factors like grade, symptoms, and etiology, ranging from conservative care to surgical options like decompression, fusion, and instrumentation.
4) Studies show surgery with fusion has better outcomes for pain and function than nonsurgical treatment or decompression alone for degenerative
Pp for lumbarization and sacralization by Dr Dhruv Taneja Assistant ProfessorDhruv Taneja
Lumbarization is a condition where the first sacral vertebra appears like a lumbar vertebra rather than being fused with the sacrum. This occurs when the first and second sacral segments fail to fuse during development. A lumbarized S1 vertebra may have its own disc or an underdeveloped disc space, making it difficult to accommodate and more prone to injury with age. Sacralization is a related condition where the fifth lumbar vertebra fuses with the sacrum, reducing mobility and increasing stress on the L4 vertebra. Both conditions can potentially lead to back pain and disc problems.
The document provides information on normal EEG wave patterns. It discusses the different wave types (delta, theta, alpha, beta), their typical frequencies, amplitudes, and locations. It also summarizes the normal EEG patterns seen in wakefulness, drowsiness, different sleep stages, and across age groups from newborns to older adults. Key aspects like alpha rhythm, sleep spindles, vertex waves, and age-related changes are outlined.
The radial nerve arises from the posterior cord of the brachial plexus and passes posterior to the axillary artery between the triceps muscle heads. It lies in the spiral groove on the humerus and pierces the lateral intermuscular septum to run between the brachialis and brachioradialis muscles. At the lateral epicondyle, the radial nerve divides into the posterior interosseous nerve and superficial radial nerve. The radial nerve supplies all the extensor muscles of the forearm and arm, and the brachioradialis muscle. Damage to the radial nerve in the spiral groove causes wrist drop but spares elbow extension.
Radial nerve palsy following humerus shaft fractures has controversial management. Spontaneous recovery occurs in over 70% of cases within 3-4 months. Early exploration is only clearly indicated for open fractures or nerve palsies associated with surgery. For secondary palsies, exploration does not improve recovery compared to nonsurgical management. Tendon transfers are considered if palsy persists after a year to restore function while further recovery remains possible.
1) The radial nerve is a mixed nerve that arises from the brachial plexus and provides motor innervation to muscles in the posterior arm and extensor compartment of the forearm as well as sensory innervation to the posterior arm and dorsal hand.
2) Radial nerve palsy presents with weakness of wrist and finger extension as well as loss of sensation over the dorsal hand; compression of the radial nerve can occur at various locations along its course.
3) Diagnosis involves detailed neurological examination to localize the site of injury and determine the functional deficit as well as electrodiagnostic testing to confirm the diagnosis.
EEG variants, are always to be recognized while interpreting the EEG one must be aware of these. Major and most common EEG is variants are discussed in the stated presentation.
Syed Irshad Murtaza.
Radial Nerve is very important topic for first year MBBS Students and as well as for day today clinical practice. This slide gives you full course & relations with clear diagrams as well as applied anatomy with clinical Co-relation.
The radial nerve originates from cervical and thoracic nerve roots and is the largest branch of the brachial plexus. It provides cutaneous innervation to the posterior arm and forearm and motor innervation to triceps, brachioradialis, and extensor muscles of the forearm and hand. The radial nerve is vulnerable to compression at the radial tunnel as it travels through the forearm. Compression can cause radial tunnel syndrome. The superficial branch of the radial nerve can be affected by Wartenberg syndrome. Radial nerve palsy can result from fractures, injuries, tumors, or iatrogenic causes.
Este documento describe la electroencefalografía (EEG), un examen que registra la actividad eléctrica del cerebro. Explica cómo se colocan los electrodos en la cabeza siguiendo el sistema 10-20 internacional y cómo se amplifican, filtran y registran las señales cerebrales. Además, describe las diferentes ondas cerebrales como delta, theta, alfa y beta según su frecuencia e implicaciones funcionales y clínicas.
Normal EEG patterns, frequencies, as well as patterns that may simulate diseaseRahul Kumar
This presentation discusses the vast range of traces that show the variations in normal EEG patterns, as well as discussing the frequency and amplitudes of various normal waveforms.
The document discusses the function and history of EEG and describes different brain wave patterns. It summarizes:
1) EEG measures brain waves through electrodes placed on the scalp, detecting voltage fluctuations from neuron action potentials. It uses silver electrodes to obtain accurate readings through the skull and other tissues.
2) There are different brain wave patterns associated with different brain states and sleep stages, including alpha waves during relaxation, beta waves during activity, theta waves during drowsiness, and delta waves during deep sleep.
3) The history of EEG began in 1875 with experiments localizing brain functions, and the first human EEG was recorded in 1924, leading to discoveries of additional wave types and correlations with brain states.
EEG is a technique that measures electrical activity in the brain using electrodes placed on the scalp. It records brain wave patterns which are categorized by frequency into different types like beta, alpha, theta, and delta waves. EEG is used to diagnose brain conditions, locate seizures or lesions, and study cognitive processes. It involves placing electrodes on the scalp, amplifying the tiny electrical signals, filtering out noise, and analyzing the brain wave patterns.
EEG is used to record the electrical activity of the brain. It uses electrodes placed on the scalp that are smaller than those used in ECGs. EEG can be used to diagnose neurological disorders like epilepsy. There are different types of brain waves like delta, theta, alpha, beta, and gamma waves that are defined by their frequency ranges and locations in the brain. Evoked potentials involve stimulating specific sensory pathways and measuring the electrical response in certain brain areas to help diagnose conditions.
GENERAL APPROCH TO NERVE INJURY AND RADIAL NERVE INJURY MANAGEMENT.pptxmanoj bhatt
This seminar discusses radial nerve palsy management. The radial nerve supplies motor innervation to extensors in the arm, forearm, and hand. It also provides sensory innervation to the posterior arm and hand. The presentation reviews the effects of peripheral nerve injury, including motor, sensory, reflex, and autonomic changes. Investigations like EMG, NCV and imaging can help evaluate the injury. Conservative management includes splinting. Surgical options include nerve repair, transfer and grafting to bridge gaps when ends cannot be approximated primarily.
The radial nerve provides motor innervation and sensory innervation to parts of the arm and forearm. Radial nerve injuries can occur due to fractures, lacerations, or compression neuropathies. Treatment depends on the level and severity of injury, and may involve nerve repair/grafting, tendon transfers, or splinting. Common tendon transfers include the palmaris longus to extensor pollicis longus, flexor carpi ulnaris to extensor digitorum communis, and pronator teres to extensor carpi radialis brevis. Postoperative splinting and rehabilitation are important after surgical treatment of radial nerve injuries.
This document provides information on the diagnosis and classification of nerve injuries, as well as details on specific nerves including their anatomy, causes of injury, clinical features, and management approaches. It discusses the axillary, radial, ulnar, median, sciatic, femoral, and lumbosacral plexus nerves. Diagnosis involves history, examination, and investigations such as nerve conduction studies, electromyography, and imaging. Surgical management of nerve injuries includes neurolysis, nerve repair, grafting, and the use of nerve conduits.
This document discusses radial nerve injury and management. It begins with the anatomy of the radial nerve, describing its course from the posterior cord through the arm, forearm, and hand. It then covers the etiology, types, clinical features, diagnostic tests, and electrophysiological evaluation of radial nerve injuries at different levels. Specific conditions involving radial nerve compression are also explained, such as Wartenberg's syndrome and posterior interosseous nerve syndrome. The document provides a comprehensive overview of radial nerve anatomy and the clinical assessment and management of various radial nerve injuries.
Radial Nerve palsy, Anatomy, Diagnosis and Management.pptxShibuB6
This document provides information about radial nerve palsy, including:
1) The anatomy and course of the radial nerve from the brachial plexus through the arm and forearm.
2) Common causes of radial nerve injury such as fractures, dislocations, and prolonged pressure.
3) Clinical features of radial nerve lesions depending on the location of injury.
4) Electrodiagnostic studies that can help diagnose and assess the severity and location of nerve damage.
5) Treatment options for radial nerve palsy including splinting, electrical stimulation, nerve glides, and surgery.
The radial nerve is the largest terminal branch of the posterior cord. It arises from spinal cord segments C5-T1 and innervates all muscles in the posterior arm and forearm compartment as well as skin on the posterior arm and forearm. In the arm, it passes between the triceps muscles before entering the spiral groove on the humerus. It continues down the humerus, piercing the lateral intermuscular septum and supplying muscles of the anterior arm. In the forearm, it divides into superficial and deep branches, with the deep branch becoming the posterior interosseous nerve. Radial nerve injuries are commonly caused by fractures of the humerus. Nonoperative treatment focuses on preventing contract
Diagnosis and principles of management of radial^J.pptxArpanKatwal2
1. The radial, median, ulnar, and sciatic nerves are commonly injured nerves that were discussed. The radial nerve has the best prognosis after injury.
2. Specific tests were described to evaluate injuries to each nerve including the wrist drop test for radial nerve and Froment's sign for the ulnar nerve.
3. Principles of nerve injury management include early active motion, preventing contractures, and surgical options like nerve exploration, neurolysis, neurorrhaphy and grafting depending on the severity and timing of injury. Factors like age, time to repair, and level of injury affect outcomes.
Nerve conduction studies (NCS) involve stimulating peripheral nerves and recording electrical responses to evaluate the nerves' electrical properties. NCS can diagnose focal and generalized nerve disorders, differentiate between nerve and muscle disorders, and classify abnormalities as axonal or demyelinating. Sensory nerve action potentials and motor compound muscle action potentials are recorded. Analysis of latency, amplitude, duration and conduction velocity provides information about nerve damage localization and severity. Electromyography detects electrical activity in muscles and identifies normal, denervated, and reinnervating states. Together, NCS and EMG objectively assess peripheral nerve and muscle disorders.
Nerve conduction studies test the function of motor and sensory nerves by measuring nerve conduction velocity. Small electrical stimuli are applied to nerves while recordings are made from muscles. Abnormalities may indicate conditions like peripheral neuropathy or radiculopathy. The test evaluates nerves like the median and ulnar nerves and can help diagnose disorders affecting the peripheral nervous system.
Brachial plexus surgery basic concepts Usman Haqqani
Nerve injuries can occur through various mechanisms and be classified based on severity. Electrodiagnostic studies and imaging help evaluate the degree of injury. For severe injuries, exploration may be needed for neurolysis, neurorrhaphy, grafting, or nerve transfers to restore function. The timing and type of surgical intervention depends on the severity, location, and symptoms in each individual case.
Peripheral nerve injuries can occur through various mechanisms and be classified in different ways. The median, radial, and ulnar nerves are commonly injured in the upper limb. Examination of specific muscles innervated by each nerve helps to localize the level and severity of injury. Precise history taking and clinical assessment including motor, sensory and trophic changes are needed to diagnose peripheral nerve lesions.
1. This document discusses principles of peripheral nerve repair, including making an accurate diagnosis, determining the injury mechanism, timing of repair, adequate debridement of nerve stumps, use of microsurgery, and postoperative management.
2. Specific techniques are presented, such as cable grafts to bridge nerve gaps and nerve transfers to restore shoulder function. Complications from various injuries like gunshot wounds and traumatic false aneurysms compressing nerves are also reviewed.
3. Hereditary conditions like Hereditary Neuropathy with Liability to Pressure Palsies that increase susceptibility to nerve injuries are mentioned.
The document summarizes techniques for peripheral nerve repair. It describes nerve anatomy, types of nerve injuries including stretching, compression and laceration injuries. It discusses the process of nerve degeneration and regeneration after injury. Surgical techniques for nerve repair including epineurial and perineurial neurorrhaphy are outlined. Primary and secondary nerve repair indications and techniques are also covered.
Peripheral nerve injuries can occur through various mechanisms including trauma, compression, and ischemia. Peripheral nerves have a complex anatomy consisting of bundles of axons surrounded by connective tissue layers. Injuries are classified based on the severity of axonal damage. Common peripheral nerve injuries involve the radial, median, and long thoracic nerves. A thorough history and focused neurological examination are needed to localize the site of injury and determine the functional impairment.
This document discusses the history and techniques of peripheral nerve repair. It notes that peripheral nerves have the ability to regenerate after injury, unlike the central nervous system. The key points covered include:
- The timeline of discoveries and advances in peripheral nerve repair from the 17th century to present day.
- The anatomy of peripheral nerves and the different layers (epineurium, perineurium, endoneurium)
- Grading systems for peripheral nerve injuries.
- Pre-operative evaluation techniques like nerve conduction studies and EMG.
- Surgical techniques for different types of injuries like transection, avulsion or neuroma in continuity.
- Microsurgical techniques like
The radial nerve originates from the brachial plexus and supplies the posterior compartment of the upper limb. It is susceptible to injury which can result in wrist drop. Non-operative treatment involves splinting while surgery may involve nerve repair, neurolysis or tendon transfers to restore function. Post-operative rehabilitation focuses on protecting tendon transfers while regaining range of motion.
This document provides an overview of peripheral nerve injuries. It discusses the anatomy of peripheral nerves and their formation from spinal nerves. Common mechanisms of peripheral nerve injury are described, including fracture, laceration, burns, and compression. The process of neuronal degeneration and regeneration after injury is explained. Seddon's and Sunderland's classifications of nerve injuries based on the severity of injury are introduced. Finally, the document begins to describe specific regional nerve injuries, focusing on injuries to the brachial plexus, radial nerve, median nerve, and injuries causing "wrist drop" and "finger drop".
Benign aggressive bone tumors are a group of tumors that are locally aggressive but rarely metastasize. Some examples included are giant cell tumor, chondroblastoma, osteoblastoma, chondromyxoid fibroma, and Langerhans cell histiocytosis. Giant cell tumor most commonly affects the distal femur, proximal tibia, and distal radius in patients aged 20-40 years. Treatment involves extended curettage with adjuvants and bone grafting to achieve local control while preserving joint function. Recurrence rates are 5-15%.
This document discusses coxa vara, which is a hip deformity characterized by an abnormal decrease in the femoral neck-shaft angle. It classifies coxa vara as congenital, developmental, or acquired. Developmental coxa vara is the most common type and is caused by a primary cartilage defect in the femoral neck. Clinical features include limping and pain. Treatment involves corrective valgus osteotomies to restore the neck-shaft angle and relieve stress on the femoral physis. The document describes several techniques for valgus osteotomy including Pauwel's, Borden's, and subtrochanteric osteotomy. The goal of surgery is to stimulate healing of the femoral neck defect and restore normal
This document provides information on meniscal tears of the knee. It begins with an introduction stating that meniscal tears are common injuries responsible for many arthroscopies annually. It then covers anatomy of the medial and lateral menisci, blood supply, classification of tears, mechanisms of injury, clinical features, investigations like MRI and arthroscopy, and treatment options including non-operative care, meniscectomy, and meniscal repair. The focus is on providing detailed information on meniscal anatomy, tears, and surgical and non-surgical management.
This document provides information about soft tissue tumors. It discusses the epidemiology, classification, etiology, diagnosis and treatment of both benign and malignant soft tissue tumors. Some key points include:
- Benign soft tissue tumors are more common than sarcomas. Common benign tumors include lipomas, schwannomas and giant cell tumors of the tendon sheath.
- Risk factors for soft tissue sarcoma include exposure to herbicides/pesticides, radiation exposure, genetic conditions and viral infections.
- MRI is usually the best imaging modality for evaluating soft tissue tumors. Biopsy is needed for diagnosis.
- Treatment depends on whether the tumor is benign or malignant. Benign tumors may
This document discusses compartment syndrome, including its definition, relevant anatomy, causes, pathophysiology, diagnosis, and treatment. Compartment syndrome is an elevation of pressure within a closed muscle compartment that restricts blood flow. The most common causes are tibial and forearm fractures. Diagnosis is based on pain disproportionate to the injury that increases with stretch, and measurement of intracompartmental pressure over 30 mmHg. The only effective treatment is urgent surgical fasciotomy to release the fascial compartment and restore blood flow. Early diagnosis and treatment are important to prevent permanent muscle and nerve damage.
This document provides guidance on evaluating a limping child. It begins with an introduction stating that limping is a common complaint in pediatrics that can be caused by benign or serious conditions. The document then covers pathophysiology, differential diagnosis, history taking, physical exam findings for normal and pathological gaits, investigations including imaging and labs, and key takeaways. The physical exam section describes assessment of gait, standing, supine, and prone positions as well as specific tests. Red flags include age under 3, inability to bear weight, fever or systemic illness. The conclusion emphasizes taking an acute limp seriously and considering age and trauma history in evaluations.
Dr. Manoj Das' document provides an overview of examining the foot and ankle. It discusses the anatomy of the foot and ankle including bones, joints, ligaments and muscles. The examination involves taking a history, observing gait, posture and deformities, palpating for tenderness, and assessing range of motion, neurovascular status, and performing special tests. The goal is to assess, diagnose and treat conditions of the foot and ankle.
STUDIES IN SUPPORT OF SPECIAL POPULATIONS: GERIATRICS E7shruti jagirdar
Unit 4: MRA 103T Regulatory affairs
This guideline is directed principally toward new Molecular Entities that are
likely to have significant use in the elderly, either because the disease intended
to be treated is characteristically a disease of aging ( e.g., Alzheimer's disease) or
because the population to be treated is known to include substantial numbers of
geriatric patients (e.g., hypertension).
The biomechanics of running involves the study of the mechanical principles underlying running movements. It includes the analysis of the running gait cycle, which consists of the stance phase (foot contact to push-off) and the swing phase (foot lift-off to next contact). Key aspects include kinematics (joint angles and movements, stride length and frequency) and kinetics (forces involved in running, including ground reaction and muscle forces). Understanding these factors helps in improving running performance, optimizing technique, and preventing injuries.
Pictorial and detailed description of patellar instability with sign and symptoms and how to diagnose , what investigations you should go with and how to approach with treatment options . I have presented this slide in my 2nd year junior residency in orthopedics at LLRM medical college Meerut and got good reviews for it
After getting it read you will definitely understand the topic.
Are you looking for a long-lasting solution to your missing tooth?
Dental implants are the most common type of method for replacing the missing tooth. Unlike dentures or bridges, implants are surgically placed in the jawbone. In layman’s terms, a dental implant is similar to the natural root of the tooth. It offers a stable foundation for the artificial tooth giving it the look, feel, and function similar to the natural tooth.
The skin is the largest organ and its health plays a vital role among the other sense organs. The skin concerns like acne breakout, psoriasis, or anything similar along the lines, finding a qualified and experienced dermatologist becomes paramount.
Breast cancer: Post menopausal endocrine therapyDr. Sumit KUMAR
Breast cancer in postmenopausal women with hormone receptor-positive (HR+) status is a common and complex condition that necessitates a multifaceted approach to management. HR+ breast cancer means that the cancer cells grow in response to hormones such as estrogen and progesterone. This subtype is prevalent among postmenopausal women and typically exhibits a more indolent course compared to other forms of breast cancer, which allows for a variety of treatment options.
Diagnosis and Staging
The diagnosis of HR+ breast cancer begins with clinical evaluation, imaging, and biopsy. Imaging modalities such as mammography, ultrasound, and MRI help in assessing the extent of the disease. Histopathological examination and immunohistochemical staining of the biopsy sample confirm the diagnosis and hormone receptor status by identifying the presence of estrogen receptors (ER) and progesterone receptors (PR) on the tumor cells.
Staging involves determining the size of the tumor (T), the involvement of regional lymph nodes (N), and the presence of distant metastasis (M). The American Joint Committee on Cancer (AJCC) staging system is commonly used. Accurate staging is critical as it guides treatment decisions.
Treatment Options
Endocrine Therapy
Endocrine therapy is the cornerstone of treatment for HR+ breast cancer in postmenopausal women. The primary goal is to reduce the levels of estrogen or block its effects on cancer cells. Commonly used agents include:
Selective Estrogen Receptor Modulators (SERMs): Tamoxifen is a SERM that binds to estrogen receptors, blocking estrogen from stimulating breast cancer cells. It is effective but may have side effects such as increased risk of endometrial cancer and thromboembolic events.
Aromatase Inhibitors (AIs): These drugs, including anastrozole, letrozole, and exemestane, lower estrogen levels by inhibiting the aromatase enzyme, which converts androgens to estrogen in peripheral tissues. AIs are generally preferred in postmenopausal women due to their efficacy and safety profile compared to tamoxifen.
Selective Estrogen Receptor Downregulators (SERDs): Fulvestrant is a SERD that degrades estrogen receptors and is used in cases where resistance to other endocrine therapies develops.
Combination Therapies
Combining endocrine therapy with other treatments enhances efficacy. Examples include:
Endocrine Therapy with CDK4/6 Inhibitors: Palbociclib, ribociclib, and abemaciclib are CDK4/6 inhibitors that, when combined with endocrine therapy, significantly improve progression-free survival in advanced HR+ breast cancer.
Endocrine Therapy with mTOR Inhibitors: Everolimus, an mTOR inhibitor, can be added to endocrine therapy for patients who have developed resistance to aromatase inhibitors.
Chemotherapy
Chemotherapy is generally reserved for patients with high-risk features, such as large tumor size, high-grade histology, or extensive lymph node involvement. Regimens often include anthracyclines and taxanes.
Summer is a time for fun in the sun, but the heat and humidity can also wreak havoc on your skin. From itchy rashes to unwanted pigmentation, several skin conditions become more prevalent during these warmer months.
Travel vaccination in Manchester offers comprehensive immunization services for individuals planning international trips. Expert healthcare providers administer vaccines tailored to your destination, ensuring you stay protected against various diseases. Conveniently located clinics and flexible appointment options make it easy to get the necessary shots before your journey. Stay healthy and travel with confidence by getting vaccinated in Manchester. Visit us: www.nxhealthcare.co.uk
How to Control Your Asthma Tips by gokuldas hospital.Gokuldas Hospital
Respiratory issues like asthma are the most sensitive issue that is affecting millions worldwide. It hampers the daily activities leaving the body tired and breathless.
The key to a good grip on asthma is proper knowledge and management strategies. Understanding the patient-specific symptoms and carving out an effective treatment likewise is the best way to keep asthma under control.
Osvaldo Bernardo Muchanga-GASTROINTESTINAL INFECTIONS AND GASTRITIS-2024.pdfOsvaldo Bernardo Muchanga
GASTROINTESTINAL INFECTIONS AND GASTRITIS
Osvaldo Bernardo Muchanga
Gastrointestinal Infections
GASTROINTESTINAL INFECTIONS result from the ingestion of pathogens that cause infections at the level of this tract, generally being transmitted by food, water and hands contaminated by microorganisms such as E. coli, Salmonella, Shigella, Vibrio cholerae, Campylobacter, Staphylococcus, Rotavirus among others that are generally contained in feces, thus configuring a FECAL-ORAL type of transmission.
Among the factors that lead to the occurrence of gastrointestinal infections are the hygienic and sanitary deficiencies that characterize our markets and other places where raw or cooked food is sold, poor environmental sanitation in communities, deficiencies in water treatment (or in the process of its plumbing), risky hygienic-sanitary habits (not washing hands after major and/or minor needs), among others.
These are generally consequences (signs and symptoms) resulting from gastrointestinal infections: diarrhea, vomiting, fever and malaise, among others.
The treatment consists of replacing lost liquids and electrolytes (drinking drinking water and other recommended liquids, including consumption of juicy fruits such as papayas, apples, pears, among others that contain water in their composition).
To prevent this, it is necessary to promote health education, improve the hygienic-sanitary conditions of markets and communities in general as a way of promoting, preserving and prolonging PUBLIC HEALTH.
Gastritis and Gastric Health
Gastric Health is one of the most relevant concerns in human health, with gastrointestinal infections being among the main illnesses that affect humans.
Among gastric problems, we have GASTRITIS AND GASTRIC ULCERS as the main public health problems. Gastritis and gastric ulcers normally result from inflammation and corrosion of the walls of the stomach (gastric mucosa) and are generally associated (caused) by the bacterium Helicobacter pylor, which, according to the literature, this bacterium settles on these walls (of the stomach) and starts to release urease that ends up altering the normal pH of the stomach (acid), which leads to inflammation and corrosion of the mucous membranes and consequent gastritis or ulcers, respectively.
In addition to bacterial infections, gastritis and gastric ulcers are associated with several factors, with emphasis on prolonged fasting, chemical substances including drugs, alcohol, foods with strong seasonings including chilli, which ends up causing inflammation of the stomach walls and/or corrosion. of the same, resulting in the appearance of wounds and consequent gastritis or ulcers, respectively.
Among patients with gastritis and/or ulcers, one of the dilemmas is associated with the foods to consume in order to minimize the sensation of pain and discomfort.
Nano-gold for Cancer Therapy chemistry investigatory projectSIVAVINAYAKPK
chemistry investigatory project
The development of nanogold-based cancer therapy could revolutionize oncology by providing a more targeted, less invasive treatment option. This project contributes to the growing body of research aimed at harnessing nanotechnology for medical applications, paving the way for future clinical trials and potential commercial applications.
Cancer remains one of the leading causes of death worldwide, prompting the need for innovative treatment methods. Nanotechnology offers promising new approaches, including the use of gold nanoparticles (nanogold) for targeted cancer therapy. Nanogold particles possess unique physical and chemical properties that make them suitable for drug delivery, imaging, and photothermal therapy.
2. • Largest branch of the brachial plexus
• Arises from the posterior cord of the brachial plexus (C5–T1)
• Mixed nerve
Radial Nerve
Anatomy
3. Course of Radial Nerve (RN) in the arm
In the axilla, RN lies
anterior to
subscapularis, teres
major and LD
• Sensory supply:
Posterior cutaneous
nerve of arm
RN leaves the axilla
via the triangular
space
• Motor supply:
long head of
Triceps
It then comes to lie
along spiral groove
on posterior aspect of
humeral shaft along
with arteria profunda
brachii
• Motor: medial and lateral
heads of triceps,
Anconeus
• Sensory: posterior
cutaneous nerve of
forearm, lower lateral
cutaneous nerve of arm
4. RN then leaves the
spiral groove by
piercing the lateral
intermuscular septum
to enter the anterior
compartment of the
arm, 10-12 cm above
the lateral epicondyle
• Motor supply: Brachialis
(lateral part), BR, ECRL
Anterior to lateral
epicondyle, RN divides
into its terminal branches
• Terminal branches:
Posterior Interosseous Nerve
(PIN) and Dorsal or
Superficial radial sensory
nerve
Here it lies b/w brachialis and BR
5. Deep terminal branch →
Posterior interosseous
nerve (PIN)
Supinator
EIP
EDC and EDM
ECU
ECRB
Superficial terminal
branch
Radial Nerve Proper
EPL
EPB
APL
PIN reaches the back of
forearm by passing
around the lateral aspect
of the radius b/w the
superficial and deep
heads of the Supinator
to supply all extensor
compartment muscles
Finally, PIN ends by
supplying carpal joint
sensation
6. BR
ECRL
Dorsal Radial Sensory
Nerve
Dorsal digital nerves
Radial styloid
8 cm
Dorsal radial nerve
courses through the
forearm immediately
deep to the BR
It emerges b/w
tendons of BR and
ECRL ≈ 8 cm
proximal to radial
styloid, to become
subcutaneous
It crosses the
anatomical snuffbox
b/w EPB and EPL,
dividing into multiple
branches to supply
sensation to hand
Course of Radial Nerve (RN) in the
forearm
7. Lower lateral cutaneous
nerve of arm
Posterior cutaneous
nerve of arm
Posterior cutaneous
nerve of forearm
Dorsal radial sensory
nerve
Gives sensibility to the
dorsum of the hand over the
radial two-thirds, the dorsum
of the thumb, and the index,
middle finger proximal to the
distal interphalangeal joint.
Cutaneous innervation from radial
nerve
8. - crutch palsy
- aneursysm of axillary
vessels
Total palsy
Aetiology and clinical features
Very high radial nerve
palsy
Clinical features
9. - # shaft of humerus
-prolonged application of
tourniquet
-pressure on arm as in
Saturday night paralysis
-injections
-from excessive callus
formation of old fracture
impinging on the nerve
- Elbow extension spared
- Lost: Wrist, thumb and
finger extension; sensation
over 1st web space
High radial nerve palsy Clinical features
10. -Dislocation of elbow
-#neck of radius
-Enlarged bursae
-Rheumatoid synovitis of
elbow
-During operation for
excision of radius head
- Elbow extension spared
with weak wrist extension
and radial deviation
- Lost – thumb , finger
extension: sensory over
dorsum of 1st web space
Low radial nerve palsy Clinical features
12. Mechanism of injury (e.g. sharp
penetrating vs. blunt trauma)
Timing of injury
Loss of motor and sensory function
Presence of pain
Interval recovery of function in patients
presenting late
History
13. Assessment of motor function
Assessment of sensory function
Assessment of involved joints
Physical
Examinatio
n
Individual muscles innervated by
the nerve are tested to determine
what is functioning and what is not:
▪Helps to determine the level of
injury
▪Guides future surgical planning
▪Elicitation of Tinel’s sign
▪Specific sensory testing
Each joint is taken through its
passive range of motion to assess
for suppleness → presence of fixed
joint contractures in delayed
presentations is associated with
poor treatment outcomes
14. Specific sensory tests
Test Perception Main receptor Comments
Static 2 point
discrimination (2PD)
Tactile Merkel cell ▪Evaluates sensory
receptor innervation
density
▪Normal distance:
6mm
Moving 2PD Tactile Meissner corpuscle ▪Normal distance:
3mm
Tuning fork (250 Hz) Vibration Pacinian corpuscle
Tuning fork (30 Hz) Vibration Meissner
Semmes-Weinstein
monofilament test
Pressure Merkel
Ten test (moving light
touch)
Pressure Merkel ▪Reliability
comparable to
monofilament test
Cold-heat test Temperature Free nerve endings•Changes in Vibration and Pressure thresholds are seen in early nerve compression but are unreliable for
evaluating nerve lacerations
•Changes in sensory receptor innervation density (2PD) are seen in chronic nerve compression but are
reliable for evaluating nerve lacerations
15. Commonly used EDT
-Electromyography (EMG)
-Nerve conduction studies (NCS)
1. Documentation of injury
2. Location of insult
3. Severity of injury
4. Recovery pattern
5. Prognosis
6. Objective data for impairment documentation
7. Pathology
8. Selection of optimal muscles for tendon transfer procedure
Electrodiagnostic testing
16. Limitations of EDT:
▪Evaluates only large myelinated fibres → smaller axons conveying
pain and temperature are not assessed
▪Changes in unmyelinated nerve fibres, which are the first to be
affected in nerve compressions, are not evaluated
▪Performing the test before 3-6 weeks post injury can give
inaccurate results
▪Very proximal or distal nerve injuries are difficult to assess
▪Unreliable assessment of multi-level injuries
▪Examiner dependant
17. Nerve conduction studies (NCS)
2 electrodes are placed along the course of the
nerve. The first electrode stimulates the nerve
to fire, and the second electrode records the
generated action potential
Amplitude
• represents the size of the
response
• proportional to the number
of depolarizing axons in
the nerve
Latency
• the delay in response
following stimulation
Conduction velocity
Sensory nerve action
potential (SNAP)
• Response obtained when
the recording electrodes is
placed proximally along
the sensory nerve, toward
the spinal cord
Compound motor action
potential (CMAP)
• Response obtained when
the recording electrodes is
placed distally at the
target muscle
18. Electromyography (EMG)
• Activity observed when a needle
electrode is inserted into the muscle
Insertional activity
• Seen when the muscle is at rest
• Absent in normal muscles▪Fibrillation potentials
▪Fasciculations
• Generated by the muscle during a
voluntary contraction
• Evaluates the integrity of neuro-
muscular junction
Motor unit potentials
(MUPs)
19. Sequence of events in nerve
compression
Focal demyelination
Axonal damage at the
compression site
Further axonal loss
Axonal sprouting producing
collateral re-innervation
Remyelination following
decompression
▪↑Latency
▪↓Nerve conduction
velocity
Associated Electrodiagnostic
findings
▪↓SNAP
▪↓CMAP
▪↑Insertional activity
▪Fibrillation potentials and
fasciculations
▪’Giant’ MUPs
▪Normalization of NCV
▪Loss of ‘giant’ MUPs
20. Non-operative
-full passive range of motion in all
joints of the wrist and hand and
prevention of contractures, including
that of the thumb-index web
- splints
wrist drop can be treated successfully
by splints
Barkhalter has observed that grip
strength may be increased by 3 to 5
times by simply stabilizing the wrist
with splints
Many types of splints have been
described
Each patient individual need should
TREATMENT
21. INTERNAL SPLINT
Burkhalter proposed early transfer of PT-ECRB to restore
wrist extension as an adjunct to nerve repair.
It restores the power grip quickly and effectively since wrist
extension is restored
Advantages are:
It works as a substitute during nerve regrowth and largely
eliminates an external splint
Subsequently the transfer aids the newly innervated and weak
wrist extensor
It continues to act as a substitute in case nerve regeneration is
poor or absent
Green’s operative hand
22. In a sharp injury exploration is indicated for diagnostic,
therapeutic and prognostic purposes
In avulsion , blasting injures –to identification of the
nerve injury and making the ends of the nerve with
sutures for later repair.
When a nerve deficit follows blunt or closed trauma,
and no clinical or electrical evidence of regeneration
has occurred after an appropriate time, exploration of
the nerve is indicated.
INDICATIONS FOR SURGERY
23. -primary repair gives the best result with respect to
motor,sensory recovery, is indicated in clean sharp nerve
injuries and carried out in first 6-8 hours.
-delayed,primary repair carried out between 7-18days -
primary repair fascicular alignment because of minimal
excision of the nerve ends.
-Secondary repair-preferable only in crushed,avulsed
injuries where patients life is seriously endangered.it is
done at delay of 3-6 wks.
Time of surgery
24. Seddon has suggested the
maximum length of time that
may be required for motor
recovery to first manifest
itself can easily be calculated
by measuring the distance
on the x-ray from the fracture
site to the point of
innervation of the
brachioradialis muscle
(approximately 2 cm above
the lateral epicondyle)
Green's Operative Hand
Surgery
Nerve Exploration If No Return After a Longer
Waiting Period
29. Tendon transfers
Arthodesis
Tendon transfers work to correct:
instability
imbalance
lack of co-ordination
restore function by redistributing remaining
muscular forces
RECONSTRUCTIVE
PROCEDURES
30. A patient with irreparable radial nerve palsy
needs to be provided with
(1) wrist extension.
(2) finger (metacarpophalangeal [MP] joint)
extension.
(3) a combination of thumb extension and
abduction.
Requirements in a Patient with Radial Nerve
Palsy
31. Robert jones described 2 sets of tendon transfers
1916: PT - ECRL and ECRB
FCU - EDC III,IV,V
FCR - EDCII,EIP and EPL
1921: PT - ECRL and ECRB
FCU - EDC III,IV,V
FCR - EDCII,EIP , EPL,APL ,EPB
TENDON TRANSFER
34. a long arm splint is applied that
immobilizes the forearm in 15 to 30degrees of pronation.
the wrist in approximately 45 degrees of extension.
the MP joints in slight (10 to 15 degrees) flexion.
the thumb in maximum extension and abduction.
The proximal interphalangeal joints of the fingers are left
free.
The cast is removed 4 weeks postoperatively; removable
short arm splints to hold the wrist, fingers, and thumb in
extension are made, which the patient wears for an
additional 2 weeks, removing them only for exercise.
Postoperative Management
36. Wartenberg’s syndrome
• Aka: Cheiralgia paresthetica
• D/t compression of Superficial radial nerve as it
emerges b/w ECRL and BR, 8 cm proximal to
radial styloid
37. isolated pain or paresthesias
over the dorsoradial aspect
of the hand
preceding history of trauma
to the area (i.e., handcuffs,
forearm fracture)
Differentiating Wartenberg’s
syndrome from de
Quervain’s tenosynovitis
A Tinel’s sign over the
superficial sensory radial
nerve is the most common
exam finding
Clinical features
presence of motor weakness
suggests a more proximal
site of compression
Also seen in patients who
use forearms in pronated
position for extended periods
→ in pronation, the tendons
of BR and ECRL approximate
and may compress the nerve
▪In WS, pain is exacerbated by pronation, while in
DQT pain is elicited with changes in thumb and wrist
position
▪DQT - normal sensation in the dorso-radial hand
▪DQT - pain on percussion over the 1st extensor
compartment
Electrodiagnostic testing is of
limited value in Wartenberg’s
syndrome
38. Posterior interosseous nerve (PIN) syndrome
• D/t compression of PIN in the radial tunnel
• Most common causes include:
▪Tumors such as lipomas, ganglia
▪Rheumatoid synovitis
▪Septic arthritis
▪Vasculitis
39. The radial tunnel is a 5 cm
space bounded by:
▪Dorsally: capsule of the
radiocapitellar joint
▪Volarly: the BR
▪Laterally: the ECRL and ECRB
muscles
▪Medially: the biceps tendon and
brachialis muscles
Within radial tunnel, there are 5
potential sites of compression:
▪fibrous bands to the
radiocapitellar joint between the
brachialis and BR
▪the recurrent radial vessels
(leash of Henry)
▪the proximal edge of the ECRB
▪the proximal edge of the
Supinator (arcade of Fröhse)
▪the distal edge of the Supinator
BR
Supinator
arcade of Fröhse
ECRL
PIN
40. Diagnosis
loss of finger and thumb extension
Weak wrist extension with radial deviation
(since ECRL innervation is intact)
Intact passive tenodesis effect
(rules out extensor tendon rupture)
EMG testing is helpful to confirm the
diagnosis and monitor motor recovery
41. Radial Tunnel syndrome
• Similar to PIN syndrome, it is also d/t
compression of PIN in the radial tunnel
• Not considered a true compression neuropathy
by some
42. Radial Tunnel Syndrome is a clinical diagnosis
Radial Tunnel
Syndrome
Tenderness over
radial tunnel
(lateral proximal
forearm, 3-4 cm distal
to lateral epicondyle
over the mobile wad)
Pain at ECRB origin
with resistance of
middle finger
extension
Pain with resisted
forearm supination
↑ Pain on combined
elbow extension,
forearm pronation,
and wrist flexion
Many types of splints have been designed for patients with radial nerve palsy, most of which offer some type of extension assist.A, In one of the less cumbersome designs, passive MP extension is provided by simple elastic webbing beneath the proximal phalanges.B, Active flexion of the PIP joints is not impeded
Transfer of pronator teres (PT) to extensor carpi radialis brevis (ECRB), transfer of flexor carpi radialis (FCR) to extensor digitorum communis (EDC), and palmaris longus (PL) to rerouted extensor pollicis longus (EPL). A and B, Volar and dorsal incisions used in combination of transfers. Note short transverse incisions over thumb metacarpal joint dorsally and wrist volarly used in rerouting EPL. C, Transfer of PT into more centralized ECRB. PT insertion is harvested with 2- to 3-cm periosteal extension strip. D, FCR transfer to EDC. FCR motor tendon attachment at 45-degree angle into recipient tendon. E and F, Transfer of PL to rerouted EPL. By rerouting EPL out of its third extensor compartment, combination of thumb abduction and extension can be achieved.