Peripheral nerve injury

CNS brain t spinal cord Puss nerves t ganglia

ventral motor efferent

tÉ
Yamashita
Letters Plexuses
dorsal sensory afferent
dorsal ganglion

0spinal
ventral

axon mylinated by Schwan cells

y

axon covered by endoneurium

axon tax on taxon t Fascicles
fa sides covered by Perineurium
fas ieles t fasidest Fasides t

nerve trunk
6
covered by epineurium

enaini
yclassifications
Seddon classification Sunderland
classification
I Seddon classification

Neuropraxia compression on nerve nerve is intact

ax o notmesis interruption of aton in segment of nerve
nerve isintact reversals
Neurotemesis complete cut of nerve may be Livreversable

2 Sunderland classification

at level of axons
at level of endoneurum
at level of perineurium
at level of epineurium

mr

diagnosis
1 neuropraxia is a
re retrograde
2 Axon o tmesis 2nd degree full recovery

3rd degree partialrecovery ÉÉ

Reversable

4th degree no recovery

S axonotemesis w assessment b Ie
Tind test i neuropraxia n si of F Pe
G
WI

New axonalprocesses grow at speed

1 2 Mm
day

mechanism of injury to nerve from normalanatomica

1 Compression nerve entrapment f fracture

structure

wound mass hematoma

2 Laceration10PM compartment
gun shout
3 burning sharp object

4 ischemia like Compartment GP

5 traction during delivery brachial Plexus
I Post hip dislocation sciatic nerve
shoulder dislocation axillary

note
may be compressed in
Radial axilla elbow
median carpal tunnel
Ulnar capital gayons canal
 cetands
carpal tunnel at wrist median N
Inst
capital tunnel at elbow ulnar n
Radial tunnel at forearm Posteriorinterosses nerve

tarsal tunnel below ankle post tibial medial side

1 injury
05CGCy injury C8 T injury
g
co'mplete
waiter's tip deformity clawhand

name age occupation

1
Then analyse the complain
Risk factors for peripheral nerve
injury
1 diabetes autoimmune 3 drugs 4 Alcohol
2

5 Ruhamatoid disease b
b Anti TB
Tenosynovitis isoni aside
b
fuelling compartment
Impression
as in
open dosed
6 Endocrine dz
wound

Physical examination laceration

M tennis

1 Motor 4 open Us closed

2 Sensory 3 Reflexes
injury
musclecutaneousnerve
p lateralaspectofarm
sensory supply CJ

goin

Tests
ability to sense distance btw 2
1 Two point discriminationspin points
dermatom i d
normally 2 gm
4 5mi pi
2points ji is Sick

2 Sterognosis ability to recognize object by touch alone

 3 Tine sign a Perction on nerve distribution
Classic sign of progressive nerve Recovery
is µ important for
pal
our
unnel
5 8 8gRegeneration Ifp
119
Tarsal
tunnel
dermatome Imytometest

f
2 point discrimination
So Sensory
testing blind
stereogenesis

sign
muscle power

Reflexes in perifral nerve injury hyporeflexia

in uppermotor hyperreflexia
injury
Deeptendonreflex

Cs biceps
C 6 brachioradialis
Cf Triceps
LY Patella
SI ankle achilles
injury to t
I 5
nerve conduction test electro myograph 7 as
i s t
surethespeedat which
Redrd electrical 4
me
impulsestravelalonga nerve
impulse thatyour
muscle produce
 follow up clinical EMG

Ds

o ti

Hs
 jet boy
donor site 1 has adequatepower 5 or 4 no oboe
Muscle power
2 Route subcutaneous 4 pink 5 in Ild
3 b Y 11 11 11
3 expendable is 2 wait
poisoning a

4 Synergistic can perform similarfunctionto the

damagedtendon
5 excursion I ID
y
jointstiffness a short 1184
limitation of movement

Recipient site I stable Joint

2 not stiff Mobile

note Jones Surgery to neat a

surgery
Mfume
Fx of 5th metatarsal bone
 NERVES
1 Median nerve motor sensory
pronatorteres
ft compartment of forearm
Isak
superficial

Lflexor carpiradialic
I palmar's longussuperficial's
flexordigitorum
pipflexion

brevis
flexor policis
I
m www.mgggggggg
lateral
lumbricals digit 2,3

anterior interosseous nerve just motor

located in
deep compartment of art forearm
forearm 4 son
b distal to
b pronator medialepicondy
flexor flexor quadratus of elbow
btwheads of
pollicis
pronates

digitorum
aflexion at
longus profundis DIP Mcp
laterally
 palmar aspect of lateral 3h fingers
sensory I lateral of palm
213
lat 34 fingers
dorsal aspect of distal phalanges of
above flexor retinaculum

injuries
1 ant interosseous injury
do ok sign pinch sign can not pinch
can't

qj
small objects
Pointed index finger due to loss of
IF PL t f Dp flexion
play no sensory loss pure motor
elbow
origin
ask Pt to do fists hand of benedication pope's blessing
when

thumb cat fingers cant flex

j
3 distal median nerve lesion below AS origin
Trist
Ape hand loss of sensation
intability via adductor site
n polices
to oppose abduct thumb ulnar
at a
atrophy in thenmuscles AI Jr abductor JM
TPP

Pure motor
sensory1

sensory
 pityfor
rep flexionin
2 Ulnar nerve motor t sensory
motor flexordigitorum profundus met
of forearm at is
ant compartment flexor Carpi ulnaris
median
Lateralcompartment Adductor pollicis
muscles of hand
therar
Median compartment53 ftp.IIIongdisitim
appalmmigis

centralcompartment
Ekiti
senso palmar dorsal aspect of medal side ofhand

palmar dorsal aspect of medial t finger

injure less severe

claw hand

Ulnar paradoxa
b
lesion elbow Apeas less severe
proximal profunda
less dawning due to loss of flexor digitorum
no flexion at dip
Canardan
distal injury claw hand deformity
MP flexion of PIP Dsp
tYs fÉf im I 8
rare 4K
flexors
hand get lumbriads
p
Egg
aw hand
 m.org

3 radidnm
motor extensor
Triceps elbow
Post Comp of arm
comp of forearms brachioradialis
post extensor carpiradialis
longus
Emily
Lentensorcarpiradia brevis

Anconeus fixation
 post interosseous nerve continuation of deep branch
of radial nerve
4 Sensory Motor

LF sup post compartment of forearmsexategniffum

Li
extensordigiti

fit
minimi
Laggan
deep post Comp of forearm
I Abductor polices longus
extensors
polices
she's
longus
extensor

extensor indicus
supinator

sup Comp hack of forearm

 deep comp bad of forearm

sensory
t dorsal aspect of hand
dorsal aspect of radial 3tz finger

injury
i
 Tap
brachial
artery

injury
a

note holestain lewis fracture spiral Fx of

distal humerus with radial displasment of the
distal fragment A Rate of radial nerve
palsy
 againstgravity Is wifi twisty
intersectionsyndrome
over syndromes I w48
cross
6 compartments was in
Ina
soso.im
tenosynoitis
E
tendons je
a
2 muscles
ECRITECRL

K 2 1140
cross
I
tendons
N
E RL
EC RB
B M
WH
t
overuse injury

O
 De Qurrain's way A

extensorpollicis IIIs
p

Median
O
nerve
steaming
 AYEE
tension's as's's
culnarn
at
p tee.it

ulnar n injury A

sciatic nerve tweeps

from sacral plexus Ly 53 innervates the muscles
of post Thigh
bicepsfemoric
Lsemitendinosa
semimembranous
at the popliteal fossa hamstring portion of
adductor magnus
it splits
4 Y tibial
common
peroneal nerve Popliteal fossa
nerve
Isemitendineous
suplateral
supMedial
Foor

CinoBorder
Cisterna

O O
 drop foot pimp bag
A motor t sensory
1 the common peroneal nerve splits at the neck of fibula
to fetersion
compartment fibularis119g
Superficial branch lateralleg 2nd digit
t dorsum of foot except webspace btw 1st
sensory

tibialis ant
tongue
anterior leg compartments Extensordigitorum
deep branches
webspace
L Extensor hallacis tongue

btw proneus tertius

122nd
digits dorsiflexors

supertial
2 tibial nerve It posterior leg compartment
Ying pain
I
solens

deep
Yntersio
tibialispost
sensory Iflexor digitorum longus

sole of Lflexor hallicus longus

foot popliteus

A
 a

notestunnel
1 Component of carpal
 6ps of compartment 3

pressure
q

Thoracic outlet

at N
d
JD