This document discusses peripheral nerve disorders, focusing on radial nerve, ulnar nerve, peroneal nerve, and tibial nerve disorders. It describes the etiology and clinical features of injuries at different levels for each nerve. Assessment involves determining the degree and type of injury through history, exam, and EMG testing. Treatment may include exploration, nerve repair/grafting, tendon transfers, splinting, and surgery depending on the specific nerve and severity of injury. The goal is to address motor and sensory deficits while preventing deformities.
This document discusses peripheral nerve disorders, focusing on radial nerve, ulnar nerve, peroneal nerve, and tibial nerve disorders. It describes the etiology and clinical features of injuries at different levels for each nerve. Assessment involves determining the degree and type of injury through history, exam, and EMG testing. Treatment may include exploration, nerve repair/grafting, tendon transfers, splinting, and surgery depending on the specific nerve and severity of injury. The goal is to address motor and sensory deficits while preventing deformities.
This document discusses peripheral nerve disorders, focusing on radial nerve, ulnar nerve, peroneal nerve, and tibial nerve disorders. It describes the etiology and clinical features of injuries at different levels for each nerve. Assessment involves determining the degree and type of injury through history, exam, and EMG testing. Treatment may include exploration, nerve repair/grafting, tendon transfers, splinting, and surgery depending on the specific nerve and severity of injury. The goal is to address motor and sensory deficits while preventing deformities.
Etiology Injured in the elbow, in the upper arm, or in the axilla The Types of Clinical Features 1. Low Lessions 2. High Lessions 3. Very High Lessions
Radial Nerve Disorders
1. Low Lessions . Etiology: fracture or dislocation at the elbow, a local wound, Iatrogenic lessions of the posterior interosseus nerve. . Clinical Features: Clumsiness, cannot extend the metacarpophalangeal joint of the hand, weakness extension and retroposition of the thumb, wrist extension is preserved.
Radial Nerve Disorders
2. High Lessions Etiology: Fracture of the humerus, prolonged torniquet pressure. Clinical Features: an obvious wrist drop, sensory loss is limited to a small patch on the dorsum around the anatomical snuffbox.
Radial Nerve Disorders
Radial Nerve Disorders
3. Very High Lessions Etiology: Trauma or operations around the shoulder, chronic compression in the axilla. Clinical Features: Weakness of the wrist and hand, the triceps is paralyzed, and the triceps reflex is absent.
Radial Nerve Disorders
ASSESSMENT 1. The degree of Injury . The history of the injury, Physical examination, Electromyography (EMG) 2. Nerve Function . Sensory and motor function
Radial Nerve Disorders
TREATMENT 1. Open injury The nerve should be explored and repaired or grafted as soon as possible
Radial Nerve Disorders
TREATMENT 2. Closed injury a. Exploration for a radial nerve injury on admission before treatment and again after manipulation or internal fixation. b. Surgery (Nerve Grafting, Tendon transfer). c. While recovery is awaited, the small joint of the hand must be put through a full range of passive movement. (with splintage)
Radial Nerve Disorders
d. If recovery doesnt occur the disability can be largely overcome by tendon transfer: Pronator teres to the short radial extensor of the wrist; flexor carpi radialis to the long finger extensor and palmaris longus to the long thumb abductor.
Ulnar Nerve Disorders
Etiology Injuries of the ulnar nerve usually near the wrist or near the elbow. The Types of Clinical features 1. Low Lessions 2. High Lessions
Ulnar Nerve Disorders
1. Low Lessions . Etiology: often caused by cut on shattered glass, entrapment of the ulnar nerve in the pisohamate tunnel (guyons canal) by a deep carpal ganglion or ulnar artery aneurism. . Clinical Features: numbness of the ulnar one and a half finger, Claw hand deformity, finger abduction is weak, loss of thumb adduction.
Ulnar Nerve Disorders
2. High Lessions Etilologi: elbow fracture or dislocation, ulnar neuritis that caused by compression of the nerve in the medial epicondylar tunnel. Clinical features: the hand isnt markedly deformed, the fingers are therfore less clawed, motor and sensory are the same as the low lession
Ulnar Nerve Disorders
Ulnar Nerve Disorders
ASSESSMENT 1. The degree of Injury . The history of the injury, examination (e.g.: froments Electromyography (EMG) 2. Nerve Function . Sensory and motor function
Physical sign) ,
Ulnar Nerve Disorders
TREATMENT a. Exploration for a Ulnar nerve injury on admission before treatment and again after manipulation or internal fixation. b. Surgery (such as nerve repairing, nerve Grafting, Tendon transfer). c. Hand physioterapy keeps the hand supple and useful
Ulnar Nerve Disorders
TREATMENT Brand Procedure Tendon transfer from M. Extensor Carpi radialis longus to Intrinsic Muscle can improve Metacarpophalangeal flexion. Zancolli Procedure Looping a slip of M. Flexor digitorum superficialis around the opening of the flexor sheath can also improve Metacarpophalangeal flexion.
Peroneal Nerve Disorders
Injuries may affect eithe the common peroneal nerve (lateral popliteal) or one of its branches the deep or supercial peroneal nerves. Clinical Features: 1. The common peroneal nerve 2. The deep peroneal nerve 3. The superficial peroneal nerve
Peroneal Nerve Disorders
1. The common peroneal nerve . Etiology: damage at the level of the fibular neck (by severe traction, splintage, and plaster cast or a ganglion from superior tibio-fibular joint). . Clinical features: drop foot, walking with a high-stepping gait, sensation is lost over the front and outer half of the leg and the dorsum of the food. Pain may be significant.
Peroneal Nerve Disorders
2. The deep peroneal nerve Etiology: anterior compartment syndrome Clinical features: pain and weakness of dorsoflexion, sensory loss in small area of skin between the first and second toes, paraesthesia and numbness on the dorsum around first web space if the distal portion is cut during operation on the ankle.
Peroneal Nerve Disorders
3. Superficial Peroneal Nerve Etiology: Lateral compartment syndrome Clinical features: pain in the lateral part of the leg and numbness or paraesthesia of the foot, may be weakness of eversion and sensory loss on the dorsum of the foot. The cutaneus branches maybe trapped and stretched by a severe injury, causing pain and sensory symptoms without muscle weakness.
Peroneal Nerve Disorders
ASSESSMENT 1. The degree of Injury . The history of the injury, Physical examination, Electromyography (EMG) 2. Nerve Function . Sensory and motor function
Peroneal Nerve Disorders
TREATMENT a. Exploration for a peroneal nerve injury on admission before treatment and again after manipulation or internal fixation. b. Surgery (such as Nerve repairing, Nerve Grafting, Tendon transfer) followed by splintage to control ankle weakness c. Tibialis posterior, Permanent Splintage, or hind foot stabilization if there is no recovery.
Tibial Nerve Disorders
Etiology: The tibial (medial popliteal) nerve is rarely injured except in open wounds. The distal part (posterior tibial nerve) is sometimes involved in injuries around the ankle. (can be fracture or dislocation) Clinical Features: Unable to plantarflex the ankle or flex the toes, sensation is absent over the sole and part of the calf, not much clawing (both intrinsic muscle and long flexors are involved).
Tibial Nerve Disorders
The posterior tibial nerve gives off a small calcaneal branch and then divides into medial and lateral plantar nerve. The posterior tibial nerve lessions cause wide sensory loss and clawing of the toes (intrinsic muscle paralysis, but long flexors is active) Injury to one of the smaller branches causes only limited sensory loss and less noticable motor weakness.
Tibial Nerve Disorders
ASSESSMENT 1. The degree of Injury . The history of the injury, Physical examination, Electromyography (EMG) 2. Nerve Function . Sensory and motor function
Tibial Nerve Disorders
TREATMENT a. Exploration for a Tibial nerve injury on admission before treatment and again after manipulation or internal fixation. b. Surgery (such as Nerve repairing, Nerve Grafting, Tendon transfer) followed by orthosis (to prevent excessive plantar flexion) and the sole is protected pressure ulceration. c. Weakness of plantar flexion can be treated by hind-foot fusion or transfer of the tibialis anterior to the back of the foot.