4.OBTURATOR NERVE.pdf
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The obturator nerve arises from the lumbar plexus and supplies motor innervation to several adductor muscles of the thigh. It can be injured due to hip dislocation, pelvic fracture, or compression by a mass. Injury results in sensory loss in the thigh and paralysis of the adductor muscles. This causes the patient to walk with a narrow base and have loss of hip adduction range of motion. Treatment involves physiotherapy like electrical stimulation and stretching exercises to prevent deformities while the nerve regenerates over months. Special tests like Tinel's sign and slump test can help evaluate an obturator nerve injury.
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Femoral nerve
The femoral nerve originates from the lumbar plexus, specifically from the L2, L3, and L4 nerve roots. It descends through the abdomen and enters the thigh behind the inguinal ligament. In the thigh, it gives off muscular branches that innervate the iliacus, sartorius, pectineus, and quadriceps femoris muscles. It also provides cutaneous innervation to the anteromedial thigh and medial knee, leg, and foot. Damage to the femoral nerve can result in weakness of hip and knee flexion and extension, with associated symptoms like buckling of the knee, difficulty lifting the thigh, and dragging of the leg.
Lumbar plexus
The lumbar plexus originates from the ventral rami of spinal nerves L1-L4 and provides motor and sensory contributions to the anterior and medial compartment of the leg as well as the abdominal wall and pelvic areas. It supplies the iliohypogastric nerve from L1 which innervates abdominal wall muscles and the pubic region, and the ilioinguinal nerve also from L1 which innervates abdominal wall muscles and the upper inner thigh and pubic area. The lumbar plexus connects to the sacral plexus via the lumbosacral trunk formed from parts of L4 and all of L5.
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Sciatic nerve
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Ulnar nerve
The ulnar nerve originates from the medial cord of the brachial plexus. It runs down the arm and enters the forearm between the two heads of the flexor carpi ulnaris muscle. In the hand, it passes through the ulnar tunnel, dividing into superficial and deep branches that provide sensory and motor innervation to portions of the fourth and fifth fingers. Lesions of the ulnar nerve can occur at different locations, with varying effects depending on whether the nerve is damaged proximally in the arm, at the elbow, in the forearm, or distally in the hand or wrist.
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Ulnar nerve
The ulnar nerve originates from the medial cord of the brachial plexus. It runs down the arm and enters the forearm between the two heads of the flexor carpi ulnaris muscle. In the hand, it passes through the ulnar tunnel, dividing into superficial and deep branches that provide sensory and motor innervation to portions of the fourth and fifth fingers. Lesions of the ulnar nerve can occur at different locations, with varying effects depending on whether the nerve is damaged proximally in the arm, at the elbow, in the forearm, or distally in the hand or wrist.
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8. COMMON PERONEAL NERVE.pdf
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Radial nerve anatomy and injuries
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Peripheral 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.
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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.
Peripheral Nerve Injury: Radial Nerve Palsy
This document provides information about radial nerve palsy and peripheral nerve injury classification. It discusses:
- The anatomy of peripheral nerves and how they can be injured through ischemia, compression, traction, laceration or burning.
- A classification system for nerve injuries from neuropraxia (reversible conduction block) to axonotmesis (axon interruption but nerve continuity) to neuronotmesis (nerve trunk division).
- Clinical signs of nerve injury like numbness, muscle weakness, and abnormal posture. Electrodiagnostic studies and tests like the Tinel's sign that can help assess nerve recovery are also outlined.
29. Peripheral nerve injury.pptx
This document provides an overview of peripheral nerve injury, including:
- The anatomy of peripheral nerves and some major nerves of the upper and lower limbs.
- Types of peripheral nerve injuries according to Seddon's classification including neurapraxia, axonotmesis, and neurotmesis.
- Common causes of peripheral nerve injury like laceration, bruising, or stretching.
- Clinical presentations vary depending on the type of injury but can include muscle weakness, sensory disturbances, and loss of function distal to the injury site.
- Diagnosis involves physical exam, neurological exam, and electrodiagnostic testing like EMG and NCV.
- PT management focuses on pain relief, range of motion, muscle
9. TIBIAL NERVE.pdf
This document discusses tibial neuropathy, including its anatomy, causes, signs and symptoms, investigations, types of injuries, and treatment options. The tibial nerve arises from the L4, L5, S1 and S2 nerve roots and supplies motor innervation to the gastrocnemius, soleus, and other calf and foot muscles. Common causes of tibial neuropathy include injection palsy, penetrating leg injuries, tarsal tunnel syndrome, and Morton's neuroma. Signs and symptoms involve sensory loss and weakness of the innervated muscles. Investigations may include MRI, EMG, and nerve conduction studies. Treatment involves conservative options like physical therapy or surgical procedures like nerve grafting or tendon transfers.
pni-180616152851.pptx
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.
Brachial Plexus Injuries.pptx
Brachial plexus injuries can damage the nerves that control the shoulder, arm, and hand. They can be classified as pre-ganglionic or post-ganglionic based on whether the injury occurs before or after the dorsal root ganglion. Investigation may include imaging like CT myelography or MRI as well as electrodiagnostic testing. Treatment depends on the type and severity of injury but may include conservative care, nerve grafting, nerve transfer, tendon transfer, or arthrodesis. The prognosis depends on factors like the specific nerves injured and whether recovery is possible.
GENERAL APPROCH TO NERVE INJURY AND RADIAL NERVE INJURY MANAGEMENT.pptx
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.
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Radial nerve palsy clinical features and diagnosis
Radial nerve palsy clinical features and diagnosis
GENERAL APPROCH TO NERVE INJURY AND RADIAL NERVE INJURY MANAGEMENT.pptx
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22.CHICKEN POX.pdf
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Diphtheria is caused by a bacterial infection of the respiratory tract or skin by Corynebacterium diphtheriae, which produces a toxin. The bacteria do not invade deeply but multiply locally, causing tissue necrosis and formation of a pseudomembrane. The toxin can also enter the bloodstream and cause neurological or heart complications. Symptoms vary depending on the site of infection but may include throat swelling, difficulty breathing, and skin lesions. Diagnosis involves culturing samples from infected sites. Treatment involves antitoxin administration, antibiotics, and supportive care such as airway management for laryngeal infections. Complications can affect the heart or nerves if not properly treated.
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5.FEMORAL NERVE.pdf
The femoral nerve originates from the lumbar plexus and innervates muscles in the anterior compartment of the thigh. Causes of femoral neuropathy include pelvic or femoral fractures, hip dislocations, spinal issues, and diabetes. Symptoms include sensory loss and weakness of the quadriceps and hip flexors. Special tests like the slump test and prone knee bending test isolate compression of the femoral nerve. Electromyography can help evaluate the severity and location of nerve damage. Treatment involves addressing the underlying cause, physical therapy, bracing, and surgery in severe cases.
1.Force (Biomedical Physics) (2).pdf
Force is a push or pull that can change the motion of an object. There are three laws of motion defined by Newton:
1) An object at rest stays at rest and an object in motion stays in motion with the same speed and in the same direction unless acted upon by an unbalanced force.
2) The acceleration of an object as produced by a net force is directly proportional to the magnitude of the net force, in the direction of the net force.
3) For every action, there is an equal and opposite reaction.
Forces can be balanced or unbalanced. Balanced forces cancel each other out while unbalanced forces result in changes to motion.
1. MEDIAN NEUROPATHY.pdf
The median nerve controls movements of the hand and forearm. It arises from the brachial plexus and supplies muscles in the forearm and thenar muscles. Median neuropathy can occur from injuries in the axilla, arm, elbow, forearm, wrist or carpal tunnel. Symptoms include sensory loss and motor deficits. Physical exam may reveal deformities like ape hand. Special tests like Phalen's and Tinel's can help diagnose carpal tunnel syndrome. Electromyography and nerve conduction studies can evaluate the severity of injury and localization. Treatment involves splinting, physiotherapy, or surgery depending on the severity of injury.
Interferential Therapy (IFT).Class.pptx
Interferential therapy involves using two medium frequency alternating currents delivered through electrodes placed on the skin. The interference of these currents produces a low frequency amplitude-modulated current that can penetrate deep tissues without the pain of direct low frequency stimulation. It is used to relieve pain, increase blood flow, reduce swelling, and stimulate muscle and soft tissue healing. Parameters like amplitude-modulated frequency, current intensity, and treatment duration are adjusted based on the condition and desired physiological effects.
PSWD, LWD.pptx
Pulsed short wave diathermy (PSWD) interrupts continuous short wave diathermy output at regular intervals using electromagnetic pulses. The frequency remains 27.12 MHz but an inter-pulse interval of 20-40 ms is added. This reduces the average power by dispersing heat through circulation between pulses. PSWD is used to increase cellular activity, reduce inflammation and swelling, reabsorb hematomas, and accelerate the repair process in treatments lasting 15-60 minutes. Indications include relief of pain and inflammation and treatment of muscle and traumatic conditions. Contraindications include open wounds, metal implants, and conditions like pregnancy.
MicroWave Diathermy.pptx
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4.OBTURATOR NERVE.pdf
- 1. OBTURATOR NEUROPATHY P/B:- DR NIYATI PATEL 1
- 2. ANATOMY The obturator nerve is the chief nerve of the medial compartment of the thigh ROOT VALUE – L2,L3,L4 Arising from ventral division of the ventral primary rami of lumbar plexus MOTOR SUPPLY oAnterior division of nerve •Adductor longus •Adductor brevis •Pectineus •Gracilis oPosterior division of nerve •Adductor magnus •Adductor brevis •Obturator externus P/B:- DR NIYATI PATEL 2
- 3. P/B:- DR NIYATI PATEL 3
- 4. CAUSES • Dislocation of the hip joint • Hernia through the obturator foramen • Prolonged difficult labor • Compression of the nerve against the wall of the pelvis by any mass such as tumor or foetus • Pelvic fracture • Disease or injury to the sacroiliac or hip joints. P/B:- DR NIYATI PATEL 4
- 5. SIGN & SYMPTOMS Sensory loss of sensation over the distal medial aspect of the thigh and medial aspect of the knee. Motor The nerve that are paralyzed due to lesion to the anterior division of the obturator nerve are adductor longus, adductor brevis, gracilis and pectineus. The muscles that are paralyzed due to lesion to the posterior division of the obturator nerve are adductor magnus, obturator externus and occasionally adductor brevis. P/B:- DR NIYATI PATEL 5
- 6. Gait : - Walks with decreased base of support (<2 inch) ROM:- Active ROM loss – hip adduction , hip lateral rotation Passive ROM full & free unless there is soft tissue tightness P/B:- DR NIYATI PATEL 6
- 7. DEFORMITY Due to paralysis of the adductor muscles, the tensor fascia lata overacts hence pulls the hip into flexion, abduction deformity P/B:- DR NIYATI PATEL 7
- 8. FUNCTIONAL DISABILITY Pt is dependent for functional activities such as walking, squatting, dressing, transfers, toilet activities P/B:- DR NIYATI PATEL 8
- 9. 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 9
- 10. 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 10
- 11. SPECIAL TESTS 1. TINNEL’S SIGN 2. SLUMP TEST P/B:- DR NIYATI PATEL 11
- 12. TREATMENTS Conservative treatment is only option in the initial stages as tendon transfers for large muscles of the hip is not possible. Physiotherapy •IG stimulation to the adductor muscles. •Stimulation of gracilis, pectineus and obturator externus is not possible. •Stretching exercises for the TFL to prevent them from going into contracture and deformity. •Once the muscles gets innervated then re-education and strengthening is carried out as usual. P/B:- DR NIYATI PATEL 12
- 13. THANK YOU P/B:- DR NIYATI PATEL 13