The median nerve provides both motor and sensory functions to parts of the forearm and hand. It innervates muscles that allow pronation of the forearm, flexion of the wrist, and flexion of the fingers. Sensory innervation is provided to the palmar surface and fingertips of the lateral three and a half digits. Median nerve injuries are commonly caused by fractures near the elbow or lacerations at the wrist. Carpal tunnel syndrome results from compression of the median nerve as it passes through the carpal tunnel in the wrist.
A comprehensive guide to therapeutic ultrasound in relations to Therapeutic exercise, mobilizations + ultrasound
This Powerpoint has been created and published by www.ProHealthcareProducts.com - All Rights Reserved.
this is a presentation on atlanto-axial and atlanto-occipital joints. after reading this, most of you will know about atlas and axis, joint type, anatomy of joint, movements allowed by joint and its clinical considerations.
My seminar presentation slides. Please correct me if I've did something wrong in it. You can also leave any message thru my email, nurhanisahzainoren@gmail.com
A comprehensive guide to therapeutic ultrasound in relations to Therapeutic exercise, mobilizations + ultrasound
This Powerpoint has been created and published by www.ProHealthcareProducts.com - All Rights Reserved.
this is a presentation on atlanto-axial and atlanto-occipital joints. after reading this, most of you will know about atlas and axis, joint type, anatomy of joint, movements allowed by joint and its clinical considerations.
My seminar presentation slides. Please correct me if I've did something wrong in it. You can also leave any message thru my email, nurhanisahzainoren@gmail.com
1.Anatomy
a.Course
b.Motor distribution
c.Sensory distribution
2.Common sites affected
3.Level of median nerve injury
4.Clinical feature with various test performed
5.Various syndromes related to median nerve
6.Treatment
7.Summary
history of ilizarov, basic apparatus, technique, use examples, complications and advantages, bone transport method. management of ilizarov apparatus.
lomg term follow up and management.
osteotomy vs corticotomy.
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
2. Median nerve introduction
The median nerve is derived from both the lateral and
medial cords of the brachial plexus, with the lateral cord
providing mostly sensory axons from C6 and C7, and the
medial cord providing motor axons from C8 and T1.
it is the only nerve that passes through the carpal
tunnel. Carpal tunnel syndrome is the disability that
results from the median nerve being pressed in the
carpal tunnel.
Also called labourer’s nerve.
3.
4. Motor Functions
The median nerve innervates the majority of the muscles in the anterior forearm,and
some intrinsic hand muscles.
The Anterior Forearm
Inthe forearm, the median nerve directly innervates muscles in the superficial and
intermediate layers:
Superficial layer: Pronator teres, flexor carpi radialis and palmarislongus.
Intermediate layer:Flexor digitormsuperficialis.
The median nerve also gives rise to the anterior interosseous nerve, which suppliesthe
deep flexors:
Deep layer: Flexor pollicis longus, pronator quadratus, and the lateral half of the
flexor digitorum profundus (the medial half of the muscle is innervated by the ulnar
nerve).
Ingeneral these muscles perform pronation of the forearm, flexion of the wrist and
flexion of the digits of the hand.
5.
6.
7. HAND
innervates some of the muscles in the hand via two branches.
The recurrent branch of the median nerve innervates the thenar muscles –
muscles associated with movements of the thumb.
The palmar digital branch innervates the lateral twolumbricals – these muscles
perform flexion at the metacarpophalangeal joints of the index and middle
fingers
8.
9.
10.
11. Sensory innervation:
The median nerve is responsible for the cutaneous
innervation of part of the hand. This is achieved via two
branches:
Palmar cutaneous branch –Arises in the forearm and
travels into the hand. It innervates the lateral aspect of
the palm. This nerve does not pass through the carpal
tunnel, and is spared in carpal tunnel syndrome.
Palmar digital cutaneous branch –Arises in the
hand. Innervates the palmar surface and fingertips of the
lateral three and half digits.
12. Course of median nerve
Anterior compartment of arm
anterior compartment (anteromedial to humerus)
runs with brachial artery (lateral in upper arm / medial at elbow)
no branches in thearm
Forearm
enters the forearm between the pronatorteres and biceps tendon
travels between flexor digitorum superficialis (FDS)and flexor digitorum
profundus (FDP)
then emerges between the FDSand flexor pollicis longus (FPL)
13.
14. Hand
the nerve then enters the hand via the carpal tunnel, along with the tendons of the
FDS,FDPand FPL
Terminal branches
anterior interosseous branch (AIN)
innervates the deep volar compartment of forearm except the ulnar half ofthe FDP
palmar cutaneous branch
supplies sensory innervation to lateral palm
recurrent branch (to thenar compartment)
digital cutaneous branches
supply the radial 3 1/2 digits (palmar)
can also supply the index, long, and ring fingers dorsally
15. Clinical findings:
1. Injury at the Elbow: Supracondylar fracture of the humerus.
Motor functions: The flexors and pronators in the forearm are paralysed, with the
exception of the flexor carpi ulnaris and medial half of flexor digitorum profundus.
The forearm constantly supinated, and flexion is weak (often accompanied by
adduction, because of the pull of the flexor carpi ulnaris). Flexion at the thumb is also
prevented, as both the longus and brevis muscles are paralysed.
The lateral two lumbrical muscles are paralysed, and the patient will not be able to
flex at the MCP joints or extend at IPjoints of the index and middle fingers.
Sensory functions: Lack of sensation over the areas that the median nerve
innervates.
Characteristic signs: The thenar eminence is wasted, due to atrophy of the thenar
muscles. If patient tries to make a fist, only the little and ring fingers can flex
completely. This results in a characteristic shape of the hand, known as hand of
benediction.
16.
17. 2.Injury at the Wrist:
How it commonly occurs: Lacerations just proximal to
the flexor reticaculum.
Motor functions: Thenar muscles paralysed, as are the
lateral two lumbricals. This affects opposition of the
thumb and flexion of the index and middle fingers.
Sensory functions: Same as an injury at the elbow.
18. Median nerve clinical assessment:
1. Pronator teres (C6, C7) assessment: The patient’s forearm is extended and fully
pronated. The patient is then instructed to resist supination of the forearm by the
examiner.
19. 2. Flexor carpi radialis (C6, C7) assessment: The patient flexes the wrist
along the trajectory of the forearm. Wrist deviates ulnarly.
20. 3. Flexor digitorum superficialis (C8,
T1) assessment: To test proximal
interphalangeal joint flexion, the
supinated forearm and hand are
placed straight. This maneuver
places the finger to be tested
in mild flexion at the metacarpal–
phalangeal (knuckle) joint, and
stabilizes the remaining fingers in
extension, a position that allows
isolation of the flexor digitorum
superficialis. Ask the patient to flex
PIPjt againstresistance.
21. 4. Flexor digitorum profundus (C8,T1) assessment: To assessthe median
innervation of the flexor digitorum profundus one should concentrate on the
index finger. To do so, hold the metacarpal-phalangeal and proximal
interphalangeal joints immobile, and have the patient flex the distal phalanx
against your resistance.
22. The Thenar Group
5. Flexor pollicis longus (C8, T1)assessment:Immobilize the thumb, except the
interphalangeal joint, and then ask the patient to flex the distal phalanx against
resistance.
23. 6. Okay” or “circle” sign with anterior interosseous
nerve weakness.
A quick way to assessthe flexor digitorum
profundus and flexor pollicis longus innervation
from the anterior interosseous nerve is to ask the
patient to make an okay sign by touching the tips
of the thumb and index finger together.
With weakness in these muscles, the distal
phalanges cannot flex, and instead of the
fingertips touching, the volar surfaces of each
distal phalanx make contact.
24. 8.Abductor pollicis brevis (C8,T1) assessment: Resist movement of the thumb
away from the plane of the palm (palmar abduction), while stabilizing the
metacarpals of the
remaining fingers.
25. 9. Flexor pollicis brevis (C8, T1)
assessment
The patient flexes the thumb at the metacarpal-
phalangeal joint against resistance placed over
both the proximal and distal phalanges.
Make certain the distal interphalangeal joint does
not flex because in allowing this, substitution by
the flexor pollicis longus occurs.
Use your other hand to immobilize the first
metacarpal to reduce substitution by the
opponens pollicis.
Because of its dual innervation, even with
complete thenar motor branch palsies some
thumb flexion still occurs.
26. 10: Opponens pollicis (C8, T1)
assessment:
Have the patient forcibly maintain
contact between the volar pads of the
distal thumb and fifth digit, while you try
to pull the distal first metacarpal away
from the fifth digit. Although thumb
opposition is only innervated by the
median nerve, a combination of thumb
adduction (adductor pollicis, ulnar nerve)
and thumb flexion (flexor pollicis brevis,
deep head, ulnar nerve) may mimic
thumb opposition even when there is
complete median nerve palsy present.
27. 11. Lumbrical of second digit (C8,
T1) assessment:
Stabilize the patient’s index finger
in a hyper-extended position at
the metacarpal-phalangeal joint
and then provide resistance as
the patient extends the finger at
the MCP joint.
28. Sensory system
examination
Modality test – pain,touch,temperature ,pressure
and vibration
Functional tests –two point discrimination
Objective test –
(a) sweat test (iodinestarch test)-
dusting extremities with quinizarine powder
In denervated area powder remain dry and light gray
In normal sweating area it become deep purple
colour
29. (b)Skin resistance test
Richter dermometer is used
Absence of sweating demonstrate
increased resistance to passage of
electric current
(c)wrinkle test
denervated skin do not wrinkle on
exposure to water for prolonged period (
4*C for 30 min.)
30. • (d) Tinel’s sign-
– tested by gentle percussion along course of nerve
from distal to proximal direction.
– Tingling sensation felt by patient in distribution of
nerve.
– Tingling should persist for several seconds
• Importance of Tinel’s sign
– Whether Nerve interrupted
– Whether in Process of regeneration
– Rate of regeneration
– Success of nerve repair
31. Electrophysiological
study
Electromyography
Around 3 wks after denervation, the
muscle fibres will twitch rhythmically and
involuntarily
These fibrillations cannot be seen clinically
but can be measured by EMG
Fibrillations are called denervation
fibrillation
32. • Nerve conduction test
– First calculate threshold by stimulating on sound side
– If twice the threshold fails to produce muscle contraction
nerve conduction is absent
– Slow rate of conduction suggest damage to nerve
• Compound muscle action potential can be recorded from both
proximal and distal Forearm extensor muscles
33. CLASSIFICATIONOFNERVEINJURIES
SEDDON’S CLASSIFICATION
Neuropraxia – temporary paralysis of a nerve
caused by lack of blood flow or by pressure
on the affected nerve with no loss of structural
continuity.
Axonotmesis – neural tube is intact but axons
are disrupted. Nerves are likely to recover.
Neurotmesis – neural tube is severed. Injuries
are likely to be permanent without repair.
38. Symptoms
Hand and wrist Pain
Paraesthesia
Hypoaesthsia
Sparing of Palmar cutaneous branch supply
Patient wakes at night with burning or aching pain and shakes the hand to
obtain relief and restore sensation
Aggravated by elevation of hand
Thenar atrophy and weakness of thumb opposition and abduction may
develop late
39. Diagnosis
History
Clinical examination:
- Thenar wasting
- Phalen’s sign
- Tinel’s sign
- Carpal compression test
Electro Diagnostic Studies:
- Very reliable for evaluation
- Atypical casesmay be present
44. Management
• Splinting – prevents wrist flexion
• Corticosteroid/anesthetic injection
• Surgical decompression:Division of the transverse carpal ligament
- Open
- Endoscopic
45.
46.
47.
48. Complications
Injury to palmar cutaneous/recurrent motor branch of the mediannerve
Hypertrophic scarring
Hematoma/Arterial injury
49. Pronator teres syndrome
• High Compression neuropathy
• It is rare compared to CTSandAIS
• Misnomer Proximal forearm median nerve compression
50. Symptoms & signs
Symptoms are similar to those of carpal tunnel syndrome
Sensory disturbances
- Thumb & Index > Middle finger
Night pain is unusual and forearm pain is more common
Hand numbness on gripping
Phalen’s test negative
Symptoms provoked by resisted elbow flexion with forearm
supinated ( tightening of bicipital aponeurosis )
By resisted forearm pronation with the elbow extended
( pronator tension )
52. Anterior Interosseous Syndrome
Damage to the Anterior Interosseous Nerve
Pain in the forearm
Weakness of the gripping movement of the thumb and indexfinger(
unable to make ok sign )
Causes:
- Injury to elbow
- Injury during open/closed reduction
54. Tendon transfer in median nerve injuries
Median nerve palsy is perhaps the most devastating single nerve injury of the
upper extremity. Not only is there a loss of fine motor control and opposition,
but sensibility is lost over the area of the hand used for precision movements
and prehensile functioning.
Tendon transfer procedures to restore movement may be ineffective if
sensibility cannot be restored.
High median nerve palsy is defined as an injury proximal to the innervation of
the forearm muscles. Although PTand FCRfunctions are lost, forearm pronation
and wrist flexion are compensated for by other muscles, and do not need to be
restored.
55. Although the FDSto all four fingers is lost, flexion is maintained in the ring
and small fingers by the functioning ulnar-innervated FDPmuscle bellies.
However, even though ring and small finger flexion is preserved, grip strength
is diminished.
More importantly, there is a loss of thumb IPJflexion and index and middle
finger DIPJflexion due to loss of the AIN innervated muscles. This results in a
lack of fine motor control of the hand, which is normally provided by precise
movements of the IPJof the thumb and the IPJ’sof the index and middle
fingers.
In addition to these deficits, crucial thumb opposition is lost.
Low median nerve palsy, on the other hand, results in loss of thumb
opposition and sensory loss only. The fact that some degree of sensory
reinnervation is likely when a low median nerve injury has been repaired
makes this a potentially less devastating injury than high median nerve palsy.
56. General indications of
surgery
In sharp injury exploration for diagnostic as
well as theurapeutic purpose .Nerorrhaphy
can be done at time of exploration or
delayed
In avulsion or blast injury –to identify and
suture of nerve ends for delayed repair
No improvement since last 12 weeks
following close injury
57. Time of
surgery
Primary repair within 6-8 hours gives
best results
Delayed primary repair – between 7- 18
days
Secondary repair - 3 to 6 weeks later
.preferable in crushed
,avulsed,contaminated wounds where
patients life is seriously endangerd
58. Surgical
techniques Coaptation
Approximatingthe cut ends of nerve
in such a way that motor fasiculi
meets another motor fasiculi and
sensory to sensory
Conventionally done by 8-0 to 10-0
nylon suture
Sutureless methods includes fibrin
clots, adhesive tapes ,collagen
59. Neurolysi
s Neurolysis is dissection to free nerve
fibers
Exo Neurolysis-
removal of neuroma or binding
cicatrix
Endo Neurolysis-
seperation of of each of fasciculi
from surrounding non fascicular
tissue
60. Neurorrhaph
yNeurorrhaphy is end to end suturing of
nerve
Types
Partial Neurorrhaphy
Epineural Neurorrhaphy
Perineural (fascicular) Neurorrhaphy
Epiperineural Neurorrhaphy
Interfascicular nerve grafting
65. Nerve
grafting
A gap between cut ends more than 2.5-4
cm is indication of nerve graft
Types of grafts
Trunk graft
Cable graft
Pedicle nerve graft
Inter fascicular nerve graft
Pre vascularised nerve graft
66. Critical Limit of Delay of Suture
Return of motor function should not be
expected when suture has been delayed for
more than 15 months.
67. Reconstructive
procedure
1 Tendon transfer
2 Arthrodesis
When neighboring tendons are intact and if all
criteria for tendon transfer met ,then tendon transfer
is treatment of choice
Tendon transfer should be delayed for 6 months
68. Criteria for tendon
transfer
– Muscle power grade 5 (preferably),if not atleast grade 4
– Should have its own nerve and blood supply
– Synergistic group are chosen because of easier rehabilitation
– Age should be more than 5 years
– Disease should not progress and infection to be controlled
– Prior to transfer joint stiffness,contracture and malunion are
corrected
– Tendon transferred should not be at an acute angle