Peripheral Nerve Injury. Neurosurgeon Yoon Seung-Hwan. Anatomy . Connective tissue - major tissue componant - epineurium, perineurium, endoneurium Nerve tissue - axon, schwann cell . Peripheral Nerve Injury. Acute injury Chronic injury (entrapment neuropathy).
Peripheral Nerve Injury
- major tissue componant
- epineurium, perineurium, endoneurium
- axon, schwann cell
mild burn trauma or stretch
the timing of repair
nerves are repaired 3-4 weeks
to the distal stump : 1-2 week delay
1mm/day, 1 inch/month
several weeks-several months
Recovery within 6 weeks good prognosis
Fibrillation potentials and
positive sharp waves
Long duration, small amplitude
polyphasic motor unit potentials
negative(after 4-6weeks)-total interruption
-2년 이상 지속 시 muscle scar tissue로 대치되기 때문 에 (비가역변화) 회복불가
start : post-injury 1 month
peak : 3rd - 4th month
1. 손상범위를 정확히 알 수 있다.
2. 동반손상의 치유로 감염을 줄인다.
3. Epineurium이 두꺼워져 봉합이 쉽다.
4. 계획수술로 정확한 수술이 가능하다.
end-to-end repair : epineural/fascicular
autologous graft : sural N.
intercostal N./accessory N./cervical plexus
within 1 year
# leading cause of failure of nerve graft
6주까지 서서히 운동
과도한 관절운동은 피한다
Injured Peripheral Nerve
Evaluation of Closed Injury
1. Immediate primary repair in sharp injuries with suspected transsection of nerve
Immediate repair is especially important for brachial plexus and sciatic nerve transsections because delay leads not only to retraction but also to severe scaring
Bluntly transsected nerve best repaired after a delay of several weeks.
3. Decision - making as to whether neurolysis or resection & repair in a lesion in gross continuity based on intraoperative electrophysiological evaluation
4. Split repair with usually graft - lesion in continuity가 partial function or undergoing partial regeneration
5. Careful patient selection for operation
- 특히 plexus involved 시
6. Nerve anastomosis 의 failure 주원인은
① inadequate resectin of scarred nerve ends
② nerve suture distration
7. A good end result requiring rehabilitation from onset of treatment. Prevention of disuse, relief of pain, predicting probable end results of operative procedures.
swelling of nerve
not long history
pregnancy, oral contraceptive, endocrine abnormalities(DM…), type writer
nonsteroidal anti-inflammatory drugs
with electrodiagnostic data
Entrapment of Thoracic Outlet
-Cervial rib or anomalous transverse process of C7
-Fibromuscular bands or scalene muscle abnomality
- NCV & EMG
- Angiography – vascular anomaly
- Best op. management
and medius M.
Carpal Tunnel Syndrome
Entrapment of Radial Nerve
Entrapment of Ulnar Nerve
- Cubital tunnel
- Guyon’s canal
Motor Deficit of Ulnar Nerve
Lateral femoral cutaneous nerve injury (L1-2)
Tarsal Tunnel Syndrome