As part of a class presentation, we attempted to make this to briefly explain what Torticollis meas, the Types of presentation of Torticollis, and Management strategies for a Physiotherapist for Congenital Torticollis especially.
I hope this helps. :)
The pictures and information had been taken from internet, complied to make a brief presentation for the purpose of class presentation.
I do not own any content.
As part of a class presentation, we attempted to make this to briefly explain what Torticollis meas, the Types of presentation of Torticollis, and Management strategies for a Physiotherapist for Congenital Torticollis especially.
I hope this helps. :)
The pictures and information had been taken from internet, complied to make a brief presentation for the purpose of class presentation.
I do not own any content.
Colles fracture is the fracture at the distal end of radius, at its
cortico cancellous junction(about 2cm from the distal articular
surface).
It is not just the fracture of distal radius but the fracture
dislocation of the inferior radio-ulnar joint.
PNI with Relevant Anatomy, Etiology, Mechanism of Degenration and Regenration, Saddon's and Sunderland Classifications, Clinical symptoms and Examination (Tests) of Brachial Plexus, Radial & Median Nerve.
Colles fracture is the fracture at the distal end of radius, at its
cortico cancellous junction(about 2cm from the distal articular
surface).
It is not just the fracture of distal radius but the fracture
dislocation of the inferior radio-ulnar joint.
PNI with Relevant Anatomy, Etiology, Mechanism of Degenration and Regenration, Saddon's and Sunderland Classifications, Clinical symptoms and Examination (Tests) of Brachial Plexus, Radial & Median Nerve.
Peripheral nerve damage affecting the upper extremities can vary widely in cause and extent.
Many disorders, ranging from mild carpal tunnel syndrome to severe brachial plexopathy, need to be considered in a patient presenting with pain, sensory loss, or weakness involving the shoulder, arm, or hand.
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
Common diseases of ear, nose and throat prevalent in community level populaton of Nepal.
These are the most common conditions that the people present in primary health center level.
The slide includes the short introduction and management of those conditions and primary preventive measures in case they are far away from well equipped hospitals.
Unit 8 - Information and Communication Technology (Paper I).pdfThiyagu K
This slides describes the basic concepts of ICT, basics of Email, Emerging Technology and Digital Initiatives in Education. This presentations aligns with the UGC Paper I syllabus.
Read| The latest issue of The Challenger is here! We are thrilled to announce that our school paper has qualified for the NATIONAL SCHOOLS PRESS CONFERENCE (NSPC) 2024. Thank you for your unwavering support and trust. Dive into the stories that made us stand out!
How to Split Bills in the Odoo 17 POS ModuleCeline George
Bills have a main role in point of sale procedure. It will help to track sales, handling payments and giving receipts to customers. Bill splitting also has an important role in POS. For example, If some friends come together for dinner and if they want to divide the bill then it is possible by POS bill splitting. This slide will show how to split bills in odoo 17 POS.
The Roman Empire A Historical Colossus.pdfkaushalkr1407
The Roman Empire, a vast and enduring power, stands as one of history's most remarkable civilizations, leaving an indelible imprint on the world. It emerged from the Roman Republic, transitioning into an imperial powerhouse under the leadership of Augustus Caesar in 27 BCE. This transformation marked the beginning of an era defined by unprecedented territorial expansion, architectural marvels, and profound cultural influence.
The empire's roots lie in the city of Rome, founded, according to legend, by Romulus in 753 BCE. Over centuries, Rome evolved from a small settlement to a formidable republic, characterized by a complex political system with elected officials and checks on power. However, internal strife, class conflicts, and military ambitions paved the way for the end of the Republic. Julius Caesar’s dictatorship and subsequent assassination in 44 BCE created a power vacuum, leading to a civil war. Octavian, later Augustus, emerged victorious, heralding the Roman Empire’s birth.
Under Augustus, the empire experienced the Pax Romana, a 200-year period of relative peace and stability. Augustus reformed the military, established efficient administrative systems, and initiated grand construction projects. The empire's borders expanded, encompassing territories from Britain to Egypt and from Spain to the Euphrates. Roman legions, renowned for their discipline and engineering prowess, secured and maintained these vast territories, building roads, fortifications, and cities that facilitated control and integration.
The Roman Empire’s society was hierarchical, with a rigid class system. At the top were the patricians, wealthy elites who held significant political power. Below them were the plebeians, free citizens with limited political influence, and the vast numbers of slaves who formed the backbone of the economy. The family unit was central, governed by the paterfamilias, the male head who held absolute authority.
Culturally, the Romans were eclectic, absorbing and adapting elements from the civilizations they encountered, particularly the Greeks. Roman art, literature, and philosophy reflected this synthesis, creating a rich cultural tapestry. Latin, the Roman language, became the lingua franca of the Western world, influencing numerous modern languages.
Roman architecture and engineering achievements were monumental. They perfected the arch, vault, and dome, constructing enduring structures like the Colosseum, Pantheon, and aqueducts. These engineering marvels not only showcased Roman ingenuity but also served practical purposes, from public entertainment to water supply.
We all have good and bad thoughts from time to time and situation to situation. We are bombarded daily with spiraling thoughts(both negative and positive) creating all-consuming feel , making us difficult to manage with associated suffering. Good thoughts are like our Mob Signal (Positive thought) amidst noise(negative thought) in the atmosphere. Negative thoughts like noise outweigh positive thoughts. These thoughts often create unwanted confusion, trouble, stress and frustration in our mind as well as chaos in our physical world. Negative thoughts are also known as “distorted thinking”.
The Art Pastor's Guide to Sabbath | Steve ThomasonSteve Thomason
What is the purpose of the Sabbath Law in the Torah. It is interesting to compare how the context of the law shifts from Exodus to Deuteronomy. Who gets to rest, and why?
How to Make a Field invisible in Odoo 17Celine George
It is possible to hide or invisible some fields in odoo. Commonly using “invisible” attribute in the field definition to invisible the fields. This slide will show how to make a field invisible in odoo 17.
Operation “Blue Star” is the only event in the history of Independent India where the state went into war with its own people. Even after about 40 years it is not clear if it was culmination of states anger over people of the region, a political game of power or start of dictatorial chapter in the democratic setup.
The people of Punjab felt alienated from main stream due to denial of their just demands during a long democratic struggle since independence. As it happen all over the word, it led to militant struggle with great loss of lives of military, police and civilian personnel. Killing of Indira Gandhi and massacre of innocent Sikhs in Delhi and other India cities was also associated with this movement.
The French Revolution, which began in 1789, was a period of radical social and political upheaval in France. It marked the decline of absolute monarchies, the rise of secular and democratic republics, and the eventual rise of Napoleon Bonaparte. This revolutionary period is crucial in understanding the transition from feudalism to modernity in Europe.
For more information, visit-www.vavaclasses.com
Students, digital devices and success - Andreas Schleicher - 27 May 2024..pptxEduSkills OECD
Andreas Schleicher presents at the OECD webinar ‘Digital devices in schools: detrimental distraction or secret to success?’ on 27 May 2024. The presentation was based on findings from PISA 2022 results and the webinar helped launch the PISA in Focus ‘Managing screen time: How to protect and equip students against distraction’ https://www.oecd-ilibrary.org/education/managing-screen-time_7c225af4-en and the OECD Education Policy Perspective ‘Students, digital devices and success’ can be found here - https://oe.cd/il/5yV
3. • Peripheral nerves are bundles of axons
conducting efferent impulses from cells in
anterior horn of the spinal cord to the
muscles, and afferent impulses from
peripheral receptors via cells in the posterior
root ganglia to the cord
• All motor axons and sensory axons are coated
with myelin sheath, interrupted with nodes of
Ranvier
4. • Outside Schwann cells, axon is covered by a
connective tissue stocking called
endoneurium
• The axons that make up a nerve are separated
into bundles(fascicles) by fairly dense
membranous tissue, the perineurium
• The group of fascicles that make up a nerve
trunk are enclosed in an even thicker
connective tissue coat, the epineurium
5.
6. Sensory innervation of limbs
• Area of hypoaesthesia due to nerve injury may
be less than area of skin supplied by that
nerve because of overlap of sensory supply.
• Autonomous zone= a relatively small area of
complete anaesthesia .
• These zones are found in all nerve injury.
7.
8. Motor innervation of limb m/s
• Essential for diagnosis of nerve injury.
• Points to remember:
1) Nerve supply of particular muscles?
2 )Different muscles supplied by a nerve?
3 )action of a muscle and by what manoeuvre
can one appreciate its action in isolation?
9. Anatomical features relevant to nerve
injuries
• Relation to surface: superficial nerves are more prone to
injury by external object like median n. in wrist.
• Relation to bone: radial nerve injury in # humeral shaft
• Relation to fibrous septae: nerve may get entrapped in
septae.
• Relation to major vessels
• Course in a confined space(eg: median n. compression in
carpel tunnel syndrome)
13. Transient ischemia
• Due to transient endoneurial anoxia (due to
acute nerve compression)
• Reversible condition
• Within 15 min: numbness and tingling
• After 30 min: loss of pain sensibility
• After 45 min: muscle weakness
• Relief of compression is followed by intense
paresthesia upto 5 min.
• Feeling restored within 30 seconds and full
muscle power after 10 minutes
14. Neurapraxia
• Reversible physiological nerve conduction
block in which there is loss of some types of
sensation and muscle power followed by
spontaneous recovery after few days or
weeks.
• Due to mechanical pressure causing
segmental demyelination
• Seen in crutch palsy or tourniquet palsy
15. Axonotmesis
• Due to axonal interruption
• Loss of conduction but the nerve is in
continuity and the neural tubes are intact
• Wallerian degeneration distal to the lesion
and few millimeters retrograde
• Axonal regeneration occurs within hours of
nerve damage (1-2 mm/day), and if they are
not reinnervated within 2 years they will never
recover
16. Neurotmesis
• Division of nerve trunk
• Rapid wallerian degeneration
• Destruction of endoneurial tubes over a
variable segment and scarring prevents
regeneration of axons
• Surgical repair required
• Function may be adequate but is never
normal
19. • Diagnosis
The diagnosis of a peripheral nerve lesion
depends primarily on
a precise history
and
an exact clinical examination
20. History
• c/c= Inabilty to move a part of limb
• Weakness
• Numbness
• Cause may or may not be obvious.
• When cause is obvious: nerve affected and its
level is easy to decide.
• When cause is not obvious: history of injection
in nerve proximity, any medical causes like
leprosy, diabetes should be asked.
21. Examination
• Following observation should be made:
1. Attitude and deformity:
some peripheral nerve injuries present with
classic attitude and deformity of limb.
Wrist drop
Foot drop
Winging of scapula
Claw hand
Ape-hand deformity
Pointing index
Policeman-tip deformity
22. 2. Wasting of muscles:
- Will become obvious some time after paralysis.
-Compare opposite sound side. Slight wasting may
go missed.
3.Skin
- dry, glossy and smooth.
-pallor or cyanosis
-Trophic disturbances such as ridged and brittle
nails, shiny atrophic skin, etc
23. 4.Temperature
Paralysed part is usually colder and drier.
5.Sensory examination
-different forms of sensation to be tested in suspected case
of nerve palsy.
6.Sweat test
-to detect sympathetic function in the skin supplied by a
nerve.
-presence of sweating within an autonomous zone of an
injured peripheral nerve reassures that complete
inteurrption of the nerve has not occurred.
-starch test or ninhydrin test.
7.Motor examination
24. Regional survey of nerve injuries
Brachial Plexus injuries
Most commonly:
1. Erb’s palsy
2. Klumpke’s palsy
25. Erb’s palsy
• Injury of C5, C6 and (sometimes) C7.
• Common in overweight babies with shoulder
dystocia at delivery
• The abductors and external rotators of the
shoulder and the supinators are paralyzed.
• Arm held to the side, internally rotated and
pronated
27. Klumpke’s palsy
• Injury of C8 and T1
• Usually after breech delivery of smaller babies
• Baby lies with the arm supinated and the
elbow flexed
• Loss of intrinsic muscle power in the hand
28.
29. Long thoracic nerve
• Roots C5, 6, 7
• Supplies serratus anterior muscle
• Injury cause paralysis of the muscle causing
winging of scapula
• Complain of aching and weakness on lifting
the arm
• Test by pushing against the wall.
30. Test for long thoracic nerve injury
(winging of right scapula)
31. Spinal accessory nerve
• Root value (C2-6)
• Supplies sternomastoid muscle and upper half
of trapezius
• Injury causes severe pain and stiffness of the
shoulder, reduced ability to hitch or hunch the
shoulder, mild winging of scapula that
disappears on flexion or forward thrusting of
the shoulder
33. Axillary nerve
• Root value (C5, 6)
• Supplies deltoid and teres minor muscles
• Cutaneous branch supplies the skin over the
lower half of the deltoid (landmark: 5 cm below
the tip of acromion)
• Injury caused shoulder weakness and wasting
of the deltoid muscles
• Abduction can be initiated, but cannot be
maintained
34. • Extension of the shoulder with the arm
abducted to 900 is impossible
• Small area of numbness over the deltoid
(sergeant’s patch sign)
• Test: stabilize the scapula with one hand while
the other hand is kept on the deltoid to feel for
its contraction. Patient asked to abduct his
shoulder, inability to abduct the shoulder and
absence of the deltoid becoming taut indicates
deltoid paralysis
37. Motor branches
• Before the radial groove: long and medial heads
of triceps
• After the radial groove, before crossing the
elbow: lateral head of triceps, anconeous,
brachioradialis, extensor carpi radialis longus
• After crossing the elbow: extensor carpi radialis
brevis, the supinator
• After piercing the supinator: other extensor
muscles of the forearm and hand
38. Low lesions
• Due to # or dislocation at the elbow or to a
local wound
• Complain of clumsiness , not being able to
extend the MCP joints of the hand
• In thumb, weakness of extension and
retroposition
• Wrist extension is preserved
39. High lesions
• Due to # of the humerus or after prolonged
tourniquet pressure
• Wrist drop due to weakness of the radial
extensors of the wrist
• Inability to extend MCP joints or elevate the
thumb.
• Sensory loss to a small patch on the dorsum
around the anatomical snuff box
40. Very high lesions
• Due to trauma or operations around the
shoulder
• Also common in Saturday night palsy or crutch
palsy
• In addition to high lesions, the triceps is
paralysed and the triceps reflex is absent
41.
42. Tests for radial n.
• From proximal to distal, following muscles can be
examined:
1.Triceps
-asked to extend his elbow against resistance
Where other hands feel for triceps contraction.
2. Brachioradialis:
-asked to flex his elbow from 90 degree onwards,
keeping the forearm in mid-prone and against
resistance,brachioradialis stands out and can be
felt.
43. 3.Wrist extensors:
- “wrist drop” occur in paralysis of wrist
extensors(brachioradialis ,ECRL,ECRB,extensor
digitorum, extensor carpi ulnaris).
- Also called “ Saturday night palsy” (d/t injury of
radial n. in the axilla)
44.
45. 4.Extensor digitorum
- fn: extension at MCPJ
- “finger drop”
5.Extensor pollicis longus:
-fn: extension at IPJ of thumb
-examined by stabilising the MCPJ of thumb while
pt is asked to extend IPJ.
- “thumb drop”
46. PIN PALSY
• PIN is a branch of the radial nerve.
• purely motor innervation to the extensor
compartment.
1.finger metacarpal extension weakness.
2.wrist extension weakness.
-inability to extend wrist in neutral or ulnar deviation
-the wrist will extend with radial deviation due to
intact ECRL (radial n.) and absent ECU (PIN).
47. Median nerve
• Formed by joining of branches from lateral
and medial cords of brachial plexus.
48.
49. MOTOR BRANCHES OF MEDIAN NERVE
In the arm: nil
In the forearm:
1. proximal 1/3
2.distal 1/3
All flexors of forearm
(except FCU and medial
half of FDP)
nil
In the hand: Thenar muscles
1st two lumbricals
50. Low lesions
• Generally due to cuts in front of the wrist or
by carpal dislocations
• Unable to abduct the thumb
• Sensation lost over the radial three and a half
digits
• Long standing condition, atrophy of thenar
eminence
51. High lesions
• Generally due to forearm fractures or elbow
dislocation
• Signs: in addition to low lesions, paralysis of
long flexors to the thumb, index and middle
fingers, radial wrist flexors and the forearm
pronator muscles
• Typically hand is held with the ulnar fingers
flexed and the index straight, pointing sign
• Characteristic pinch defect (patient pinches
with distal joints in full extension)
52. Isolated anterior interosseous nerve lesions
• Extremely rare
• Signs similar to high median nerve injury but
without any sensory loss
• Usual cause: brachial neuritis which is
associated with shoulder girdle pain after
immunization or viral illness
53. • Tests: from proximal to distal, following muscles
can be examined-
1.Flexor pollicis longus:
-fn: flexion at IPJ of thumb
-asked to flex distal phalynx of thumb against
resistance while proximal phalanx is steady by
examiner.
2.Flexor digitorum superficialis and lateral half of
flexor digitorum profundus:
-”pointing index”
54. -Pointing index= on asking pt to make a fist, index
finger remains straight.
-Occurs due to paralysis of both flexors of index
finger due to median nerve palsy at level proximal to
elbow.
55. 3.Flexor carpi radialis:
- in a pt with paralysis of this muscles, the wrist
deviates to ulnar side while palmar flexion
occurs.
56. 4. Muscles of thenar eminence:out of the three m/s
of thenar eminence(abductor pollicis brevis,
opponens pollicis,flexor pollicis brevis) only two
can be examined for their isolated action.
a) Abductor pollicis brevis:
- fn: abduction of thumb
- “pen test”
- pt is asked to lay his hand flat on the table
with palm facing the ceiling, and a pen is held
above the thumb and asked him to touch the
pen with tip of his thumb.
58. b) Opponens pollicis:
- fn: to appose the tip of the thumb to other
fingers.
(swinging movement of thumb across the
palm is by adductor pollicis –supplied by ulnar
n.)
60. -thumb is in same plane as wrist(test
thenar eminence )
61. Ulnar nerve
• This nerve arises from the medial cord of the
brachial plexus.
• Root value: C7,C8 and T1
62.
63. Major motor branches of the ulnar
nerve
Muscles supplied by ulnar nerve
In the arm: nil
In the forearm:
1. proximal 1/3
2.distal 1/3
Flexor carpi ulnaris, medial half of flexor
digitorum profundus
nil
In the hand:
superficial branch
deep branch
Hypothenar m/s
Adductor pollicis,
All interossei and
Medial two lumbricals
64. Low lesions
• Injury in distal third of the forearm
• Sparing of forearm muscles but muscles of hand
are affected
• Complain of numbness of ulnar one and a half
fingers.
• Claw hand derformity with hyperextension of
MCP joints of the ring and the little fingers
• Hypothenar and interosseous wasting
• Froment’s sign positive
65. High lesions
• Common in elbow fractures or dislocations
• Motor and sensory loss are the same as in low
lesions.
• Hand is not markedly deformed because the
ulnar half of flexor digitorum profundus is
paralysed and the fingers are therefore less
clawed (high ulnar paradox)
66. Examination of individual muscles in case of ulnar n.
palsy:
1. Flexor carpi ulnaris
- asked to palmar flex the wrist against gravity and the
hand deviates towards radial side.
2.Abductor digiti minimi
- Asked to abduct the little finger against resistance
while keeping the hand flat on the table.
.
67. 3. interossei:
-fn: palmar interossei do adduction(PAD)
dorsal interossei do abduction(DAB) of the fingers at MCP
joints
EGAWA’S TEST
- For dorsal interossei(abductors) of the middle finger.
- With the hand kept on a flat table palmar surface down, pt
is asked to move his middle finger sideways.
- First dorsal interossei muscle can be separately
examinated by asking the pt to abduct the index finger
against resistance.
69. • CARD TEST
- For palmar interossei (adductors) of the
fingers
- examined by inserting a card between two
extended fingers and asked to hold tightly
while examiners try to pull the card out.
- in case of weak palmar interossei, it is easy to
pull out the card.
70. • Claw hand
hyperextensiom at MCP joint and flexion at PIP
and DIP joint( paralysis of lumbricals.)
Ulnar paradox= clawing is more marked in low
ulnar nerve palsy than high ulnar nerve
palsy(flexors of fingers are also paralysed)
In ulnar nerve palsy, only medial 2 fingers
develop clawing while all 4 fingers develop
clawing in combined median and ulnar nerve
palsies.
72. 3.Adductor pollicis:
- ” book test” or froment’s sign
( use of adductor pollicis and 1st dorsal
interosseous)
- In case of paralysis,pt will hold a book by using
flexor pollicis longus(supplied by median n.) in
place of the adductor.
- This produces flexion at the IPJ of the thumb.
74. Femoral nerve
• May be injured by a gunshot wound, by pressure
or traction during an operation or by bleeding
into the thigh
• Features indicate paralysis of quadriceps and the
patient is unable to extend the knee actively.
• There is numbness of the anterior thigh and
medial aspect of the leg
• Knee reflex is depressed
• Severe neurologic pain
76. • Most commonly injured in traumatic hip
dislocation(posteriorly) and pelvic fractures
Features include
Paralysis of hamstrings and all muscles below
the knee
Absent ankle jerk
Loss of sensation below knee except on
medial side of the leg(saphenous branch of
the femoral nerve)
Patient walks wit foot drop and a high
stepping gait
77.
78. Treatment of nerve injury
• Conservative management
Splintage of the paralysed limb
Preserve mobility of the joint
Care of skin and nails
Physiotherapy
Relief of pain: analgesics
• Operative management
1.Neurolysis
2.Nerve repair
3.Nerve grafting
4.Nerve transfer
79. Neurolysis
• Application of physical or chemical agents to a nerve
in order to cause a temporary degeneration of
targeted nerve fibres
• Operation where nerve is freed from enveloping scar
(perineural fibrosis) ; called external neurolysis
• The nerve sheath may be dissected longitudinally to
relieve the pressure from the fibrous tissue within
the nerve(intraneural fibrosis ; internal neurolysis
80. Nerve repair
• May be performed within a few days of injury or
later.
• Types:
Primary repair: Indicated in clean sharp nerve injuries;
done in the first 6 to 8 hours of injury
Delayed primary repair: Done in the first 7 to 18 days of
injury when the wound is clean and there are no other
major complicating injuries
Secondary repair: Done in crushed, avulsed injuries; done
at a delay of 3-6 weeks
81. Techniques of nerve repair
1. Nerve suture
• Indicated when the nerve ends can be brought close to
each other
• Techniques:
Epineural suture
Epi-perineural suture
Perineural suture
Group fascicular repair
82. 2. Nerve grafting
• Indicated when the gap is more than 10 cm or end to end
suture is likely to result in tension at the suture line.
• Most common nerve used is sural nerve
• Other source:
Medial antebrachial cutaneous nerve
Third webspace branch of median n
Lateral antebrachial cutaneous nerve
Palmar cutaneous and dorsal cutaneous branch of ulnar n
83. Methods of closing nerve gaps
• Mobilization of the nerve on both sides of the lesion
• Ralaxation of the nerve by temporarily positioning
the joints in a favourable position
• Alteration of the course of the nerve
• Stripping the branches from the parent nerve
without tearing them
• Sacrificing some unimportant branch if it is
hampering nerve mobilisation
84. Signs of regeneration of nerve
1. Tinel’s sign: On gently tapping over the nerve along
its course, from distal to proximal, a pin and needle
sensation is felt in the area of the skin supplied by
the nerve. A distal progression of the level at which
it occurs, suggests regeneration(1 mm/day)
2. Motor examination: The muscle supplied nearest to
the site of injury is the first to recover. The muscles
in the more distal area begin to contract as they are
reinnervated one after another (motor march:
absent in neuropraxia)
3. Electordiagnostic test: Helps in predecting nerve
recovery even before it is apparent clinically.
Electromyography
Nerve conduction study
85. Electromyography
• A graphic recording of the electrical activity of a
muscle at rest and during activity.
• A concentric needle electrode is inserted into the
muscle and connected to an oscilloscope screen and
a loudspeaker.
• Useful in deciding:
– Whethere or not a nerve injury is present
– Whether it is a complete or incomplete nerve injury
– Whether any regeneration occurring
– Level of nerve injury
86. In normal muscles
• A normal muscle at rest shows no electrical activity.
• As the patient slowly contracts the muscle there is
recruitment of one, then more and then multiple
motor units.
• A motor unit defined as the anterior horn cell in the
spinal cord, with its motor axon and the variable
number of muscle fibres it innervates in the muscle.
• In strong contraction, impulses of a number of motor
units firing simultaneously are superimposed, giving
rise to an interference pattern.
87. In denervated muscles
• The denervated muscle has spontaneous electrical
activity at rest(denervation potentials)
• These potentials are normally suppressed by
stronger nerve action potentials.
• Appears around 15-20 days after the muscle
denervation.
• As denervation progresses, more and more
denervation potentials appear.
• If these potentials have not appeared by the end
of the 2nd week of after nerve injury, it is a good
prognostic sign.
88. Nerve conduction test
• It is a measure of the velocity of conduction of
impulse in a nerve
• A stimulating electrode is applied over a point on
the nerve trunk and the response is picked up by
an electrode at a distance or directly over the
muscle
• The velocity of the conduction of the impulse b/w
any two points of the nerve can be calculated.
• The normal nerve conduction velocity of motor
nerve is 70 m/s
• Helps to determine
Whether a nerve injury is present
Whether it is a complete or partial nerve injury
Compressive lesions
89. Prognostic factors for the result of nerve repair
(suture or grafting)
Factors outside our influence
• Nerve injured (motor, sensory, mixed)
• Level of lesion (proximal – distal)
• Accompanying lesion (fractures etc.)
• Age of patient
Factors which we can influence
• Delay between injury and surgery
• Surgical technique