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3. RADIAL NEUROPATHY.pdf
- 1. RADIAL NEUROPATHY P/B :- DRNIYATI PATEL 1
- 2. ANATOMY ROOT VALUE– C5-T1 Arising from posterior cord of spinal cord MOTOR SUPPLY 1. Triceps Brachii 2. Brachioradialis 3. Anconeus 4. Supinator 5. Extensor Carpi Radialis Longus 6. Extensor Carpi Radialis Brevis 7. Extensor Digitorum 8. Extensor Digiti Minimi 9. Extensor Carpi Ulnaris 10. Abductor Pollicis Longus 11. Extensor Pollicis Brevis 12. Extensor Pollicis Longus 13. Extensor Indicis SENSORY SUPPLY P/B :- DR NIYATI PATEL 2
- 3. P/B :- DRNIYATI PATEL 3
- 4. CAUSES Axilla • Crutch palsy •Deep penetrating injury in the axilla • Diphtheria involving the radial nerve in the axilla • Lead poisoning which generally causes bilateral involvement of the radial nerve • Saturday night palsy. Upper Arm • Tourniquet’s palsy involving all three nerves • Fracture shaft humerus • Injection palsy • Gun shot or glass cut injury • Supracondylar palsy At the Elbow • Tennis elbow • Inflammation of the common extensor tendon may heal by fibrosis and compress the radial nerve • Fracture of the upper end of radius and ulna • Direct blow to the posterior interosseous nerve • A fibrous arch covers the posterior interosseous nerve as its passes through the supinator muscles and can gets compressed during forceful contraction of the muscles. • Two layers of supinator can also compress the nerve against the aponeurosis of extensor carpi radialis brevis. • Compression of the posterior interosseus nerve due to ganglia, neoplasm, bursae, VIC and fibrosis after trauma. P/B :- DR NIYATI PATEL 4
- 5. SATURDAY NIGHT PALSY Sleeping in an armchair with the limb hanging by the side of the chair (Saturday night palsy) All the muscles are affected which are supplied by radial nerve except triceps brachhi P/B :- DR NIYATI PATEL 5
- 6. POSTERIOR INTEROSEOUSNERVE SYNDROME The posterior interosseous nerve is a pure motor nerve and sequentially innervates supinator extensor carpi radialis brevis, extensor digitorum communis, extensor digiti minimi, extensor carpi ulnaris, abductor pollicis, extensor pollicis brevis, extensor pollicis longus, and extensor indicis In the case of a posterior interosseous nerve entrapment, the compression occurs within the musculotendinous radial tunnel. Motor function is lost but sensory function is remaining P/B :- DR NIYATI PATEL 6
- 7. SIGNS AND SYMPTOMS Sensory There will be loss of sensation over the following areas depending upon the level of lesion. • Posterior part of the upper arm • Lower lateral part of the arm • Posterior part of the forearm • Posterior part of the hand and the fingers up to the nail beds. The autonomous zone for the radial nerve is the first web space. When the posterior interosseous nerve only is involved then the patient will not have anesthesia of the autonomous zone as the posterior interosseous nerve is a purely motor nerve. P/B :- DR NIYATI PATEL 7
- 8. Motor Loss The following muscles will be involved depending upon the level of lesion: Triceps, brachioradialis, extensor carpi radialis longus and brevis, extensor carpi ulnaris, extensor digitorum, extensor digiti minimi, supinator, anconeus, abductor pollicies longus, extensor pollicies longus and brevis, extensor indicis. Loss of supination, wrist extension, fingers extension and thumb extension Reflex – triceps reflex diminished Gait assessment – arm swing absent P/B :- DR NIYATI PATEL 8
- 9. DEFORMITIES WRIST DROP FINGER DROP THUMB DROP P/B :- DR NIYATI PATEL 9
- 10. FUNCTIONAL DISABILITY Thepatient generally will have a poor grip due to lack of wrist extensor as fixator and cannot put objects like glasses or cups flat on the table. Following activities are not able to do – combing, eating, dressing, bathing, gripping, holding small and large objects P/B :- DR NIYATI PATEL 10
- 11. INVESTIGATION RADIOGRAPH :-shows whether there is presence of fracture MRI :- To delineate complete avulsion of nerve roots SD CURVE:- abnormality in conduction can be verified. Sharp curve, long chronaxie, low rheobase and the absence of contraction with repetitive stimuli indicates denervation. If it is done 2-3 weeks after injury, it shows the sign of denervation and to find out whether it is moderate or severe injury NCV:- To find out the severance of nerve fibers with wallerian degeneration. EMG:- it will help to find out reversible and irreversible nerve damage and will help map out whether it pre ganglionic/ post ganglionic lesion P/B :- DR NIYATI PATEL 11
- 12. TYPES OF INJURIES In Neuropraxia pain, numbness, muscle weakness, minimal muscle wasting is present. Recovery occurs within minutes to days In Axonotmesis there is pain, evident muscle wasting, complete loss of motor, sensory and sympathetic functions. Recovery time– months (axon regeneration at 1-1.5 mm/day) In Neurotmesis no pain, complete loss of motor, sensory and sympathetic functions. Recovery time – months and only with surgery P/B :- DR NIYATI PATEL 12
- 13. SPECIAL TESTS PALMTO PALM TEST TINEL’S SIGN P/B :- DR NIYATI PATEL 13
- 14. SURGICAL MANAGEMENT Surgeryindicated, when there is no improvement by 16 weeks Complete paralytic injury of more than 2 years duration, need tendon transfer Limb is immobilised for 5 weeks after surgery The requirement for restoration of wrist and hand function are: • Wrist extension • Finger metacarpophalangeal extension • Thumb extension • Stability of the carpometacarpal joints of the thumb. TENDON TRANSFER SURGERIES Transfer of pronator teres foe ECRL & ECRB Transfer of FCR for APL Transfer of FCU for long finger extensors Robot jones transfer Pronator teres for ECRL & ECRB FCU for Ext Digitorum FCR for EPL/EPB/APL P/B :- DR NIYATI PATEL 14
- 15. PHYSIOTHERAPY Pain reduction TENS Reduced inflammation and oedema keep affected limb elevated To maintain muscle properties AROM & PROM For affected and unaffected limb IG Current to the paralysed muscles Massage Splinting for functional position Cock up splint Robert jones splint P/B :- DR NIYATI PATEL 15