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Dr Saleh WaslAllah Alharby ksu.sa/DrSalehAlharby

PERIPHERAL NERVES INJURIES DR SALEH W ALHARBY Professor College of medicine Dept of Orthopedics King Saud Univ www.ksu.edu.sa/DrSalehAlharby. Dr Saleh WaslAllah Alharby www.ksu.edu.sa/DrSalehAlharby. WHAT IS A PERIPHERAL NERVE?. Dr Saleh WaslAllah Alharby www.ksu.edu.sa/DrSalehAlharby.

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Dr Saleh WaslAllah Alharby ksu.sa/DrSalehAlharby

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  1. PERIPHERAL NERVES INJURIESDR SALEH W ALHARBY ProfessorCollege of medicineDept of OrthopedicsKing Saud Univwww.ksu.edu.sa/DrSalehAlharby Dr Saleh WaslAllah Alharby www.ksu.edu.sa/DrSalehAlharby

  2. WHAT IS A PERIPHERAL NERVE? Dr Saleh WaslAllah Alharby www.ksu.edu.sa/DrSalehAlharby

  3. PERIPHERAL NERVE INJURIES Dr Saleh WaslAllah Alharby www.ksu.edu.sa/DrSalehAlharby

  4. WHAT ARE THE FEATURES OF A PERIPHERAL NERVE? • RELATES PERIPHERY AND SPINAL CORD. • MIXED (SENSORY AND MOTOR). • REGENERATES. Dr Saleh WaslAllah Alharby www.ksu.edu.sa/DrSalehAlharby

  5. OUTLINE • DEFINITION. • TYPES OF NERVE INJURIES. • FATE (pathophysiology) AND REHABILITATION. • ETIOLOGY. • PRESENTATION. • DIAGNOSIS. • CLINICAL EXAMPLES: (ERB’S,CARPAL TUNNEL,RADIAL,ULNAR,SCIATIC AND PERONEAL N.) Dr Saleh WaslAllah Alharby www.ksu.edu.sa/DrSalehAlharby

  6. DEFINITION Partial or complete interruption of normal physiology of the nerve. NERVE CONDUCTION IS AFFECTED. Dr Saleh WaslAllah Alharby www.ksu.edu.sa/DrSalehAlharby

  7. TYPES OF NERVE INJURIES 1-NEUROPRAXIA REVERSIBLE FAILURE OF PROPAGATION OF THE ELECTRICAL IMPULSE ACROSS THE AFFECTED NERVE SEGMENT WITHOUT ANATOMICAL DISTURBANCE OF THE NERVE. HRS-DAYS. SATURDAY NIGHT PALSY HONEYMOONERS SYNDROME WHEELCHAIR BOUND PERSONS Dr Saleh WaslAllah Alharby www.ksu.edu.sa/DrSalehAlharby

  8. TYPES OF NERVE INJURIES 2-AXONOTMESIS COMPLETE ABSENCE OF SENSORY AND MOTOR ACTIVITIES. DAYS-WEEKS AXONAL AND MYELIN SHEATH DAMAGE LOSS OF CELL BODY CONTINUITY TO ITS END ORGAN. ENDO,PERI AND EPINEURIUM ARE PRESERVED. PROGNOSIS FOR RECOVERY IS GOOD. Dr Saleh WaslAllah Alharby www.ksu.edu.sa/DrSalehAlharby

  9. TYPES OF NERVE INJURIES 3-NEUROTMESIS COMPLETE DISRUBTION OF ALL THE AXONS AND SUPPORTING CONNECTIVE TISSUE STRUCTURES. VERY POOR PROGNOSIS WITHOUT SURGICAL REPAIR. Dr Saleh WaslAllah Alharby www.ksu.edu.sa/DrSalehAlharby

  10. FATE AND REHABILITATION • WALLERIAN DEGENERATION 1 MM PER DAY Dr Saleh WaslAllah Alharby www.ksu.edu.sa/DrSalehAlharby

  11. Dr Saleh WaslAllah Alharby www.ksu.edu.sa/DrSalehAlharby

  12. REHABILITATION • PAIN CONTROL. • SPLINT. (AVOID PRESSURE SORES) • NERVE AND MUSCLE STIMULATION. • NEARBY JOINTS RANGE OF MOTION. • MONTHS ----- YEARS . Dr Saleh WaslAllah Alharby www.ksu.edu.sa/DrSalehAlharby

  13. ETIOLOGY • ACUTE FRACTURE WRONG POSTURE SURGERY ELECTRICAL BURN • CHRONIC TIGHT NERVE PASSAGE TUMORS Dr Saleh WaslAllah Alharby www.ksu.edu.sa/DrSalehAlharby

  14. PERSENTATION • PAIN • LOSS OF SENSATION • LOSS OF MOTION • LOSS OF POWER • LOSS OF REFLEXES • WASTING • TROPHIC CHANGES (skin,sc,neurovascular,bones,muscles) • CONTRACTURES Dr Saleh WaslAllah Alharby www.ksu.edu.sa/DrSalehAlharby

  15. DIAGNOSIS • PAIN • LOSS OF SENSATION • LOSS OF MOTION • LOSS OF POWER • LOSS OF REFLEXES • WASTING • TROPHIC CHANGES (skin,sc,neurovascular,bones,muscles) • CONTRACTURES Dr Saleh WaslAllah Alharby www.ksu.edu.sa/DrSalehAlharby

  16. DIAGNOSTIC AIDS • X-RAY • EMG • NCS • MRI Dr Saleh WaslAllah Alharby www.ksu.edu.sa/DrSalehAlharby

  17. CLINICAL EXAMPLES • ERB’ PALSY • CARPAL TUNNEL SYNDROME(MEDIAN NV) • RADIAL NERVE INJURY • ULNAR NERVE INJURY • SCIATIC NERVE INJURY • LATERAL POPLITEAL NERVE INJURY Dr Saleh WaslAllah Alharby www.ksu.edu.sa/DrSalehAlharby

  18. ERB’S PALSY • BIRTH INJURY (DIFFICULT LABOUR) • TRACTION ON NERVE ROOTS C5-6 • STRETCH-RUPTURE-AVULSION • UPPER LIMB IN EXTENSION • MOTHER NOTICE NO MOTION • 90% GOOD RECOVERY • ROLE OF SURGERY AFTER 3 MONTHS • REMEMBER PROPER REHABILITATION Dr Saleh WaslAllah Alharby www.ksu.edu.sa/DrSalehAlharby

  19. CARPAL TUNNEL SYNDROME • MEDIAN NERVE ENTRAPMENT BY FLEXOR RETINACULUM (TVS CARPAL LIGAMENT) • PAIN,NUMBNESS,NIGHT • MANUAL WORKERS • DIAGNOSIS • CONS Rx • SURGERY Dr Saleh WaslAllah Alharby www.ksu.edu.sa/DrSalehAlharby

  20. RADIAL NERVE INJURY Dr Saleh WaslAllah Alharby www.ksu.edu.sa/DrSalehAlharby

  21. ULNAR NERVE INJURY Dr Saleh WaslAllah Alharby www.ksu.edu.sa/DrSalehAlharby

  22. SCIATIC NERVE INJURY Dr Saleh WaslAllah Alharby www.ksu.edu.sa/DrSalehAlharby

  23. PERONEAL NERVE INJURY (LPN) • FOOT DROP • TIGHT POP • SKELETAL TRACTION • DIRECT INJURY (RARE) • DYNAMIC SPLINT Dr Saleh WaslAllah Alharby www.ksu.edu.sa/DrSalehAlharby

  24. QUIZ • Axon degeneration occurs from mild compression injury • The prognosis for Neuropraxia is poor • Axonotmesis is generally caused from separation of the cell body from the neuron • Wallerian Degeneration typically does not occur in Neuropraxic injury • Surgical reconstruction is necessary in Neurotmesis • Wallerian Degeneration does not occur in Neurotmesis • A ligamentous structure can cause Neuropraxia Dr Saleh WaslAllah Alharby www.ksu.edu.sa/DrSalehAlharby

  25. THANK YOU Dr Saleh WaslAllah Alharby www.ksu.edu.sa/DrSalehAlharby

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