Beruflich Dokumente
Kultur Dokumente
Date- 02-03-2016
Presenter- Moderator-
Dr. Baharul Islam Choudhury Dr. C.R.Buragohain
PGT, Orthopedics Asst. Proff
Date – 08- 06- 2016
MICRO ANATOMY
NERVE DEGENERATION & REGENERATION
HOW TO DIAGNOSE
TREATMENT
• Careful assessment of vital function.
• Clean Open wound where nerve is sharply incised
Immediate primary repair is preferred.
If patient condition does not permit it may be delayed.
• Mobilization.
• Positioning of extremity.
• Transposition.
• Bone resection.
• Nerve stretching.
• Nerve grafting.
• Tendon transfer
BRACHIAL PLEXUS INJURY
RADIAL NERVE INJURY
• It is continuation of post cord of brachial plexus.
• It is primarily motor nerve.
Very high lesion
caused by –
Trauma or operation around shoulder.
Compression in axilla ( Crutch palsy , Saturday night palsy).
Triceps is also paralysed in addition to wrist & hand.
High lesion
Caused by—
# of SOH, # S/C & # Lat condyle humerus.
Prolonged tourniquet pressure.
Wrist drop & sensory loss over dorsum around anatomical snuff box.
Low lesion
Caused by—
#, dislocation around elbow.
Operation of proximal radius.
Finger extension at MP joint is lost.
• Treatment—
Open injuries should be explored & repaired as soon as possible.
Closed injuries are 1st to 2nd deg lesion & function eventually returns.
Wrist should be splinted.
Large disability can be overcomed by tendon transfer.
ULNAR NERVE INJURY
• Arises from medial cord of brachial plexus.
• Injuries usually occur near the elbow or wrist by—
# dislocation at elbow.
Med condyle # or S/C # humerus.
Cubitus valgus deformity.
L/W or cut wound around wrist.
Direct pressure or prolonged flexion of elbow.
C/F—
• Treatment—
If nerve is divided it should be explored & repaired.
Anterior transposition at the elbow.
Tendon transfer.
Hand physiotherapy.
MEDIAN NERVE INJURY
• The nerve is formed by junction of lateral & medial cord of brachial plexus.
• Injuries are caused by—
Cut wound in front of elbow.
Carpal dislocation.
forearm # or elbow dislocation.
Stab or gunshot wound.
C/F—
• Treatment—
If nerve is divided, suture or nerve grafting should be attempted.
Post operatively wrist is splinted in flexion.
Tendon transfer is indicated if disability is severe.
LONG THORACIC NERVE INJURY
• .
• Stab injuries should be explored immediately & nerve repaired.
• If cause is uncertain, wait for 8 wks keeping the arm in sling for sign of
recovery.
• No sign of recovery after 8 wks nerve should be explored & repaired by
direct suturing or grafting.
SUPRASCAPULAR NERVE INJURY
• Arises from upper trunk of BP ( C5,6).
• Supplies supra & infra spinatus muscle.
C/F—
Atrophy of thigh muscle.
Difficult to go up a hill or stairs.
Numbness to ant thigh & medial aspect of leg.
C/F—
In complete lesion hamstring & all muscle below knee are paralysed.
Loss of sensation below knee except medial side & foot.
Walks with high stepping gait due to foot drop.
Wasting of the limb muscle.
Trophic ulcer on the sole.
• Treatment –
If nerve is divided suture or nerve grafting is done.
Recovery may take more than a year.
Foot drop splint is fitted,
Care of skin of sole.
Counteract foot drop by transfering tibialis post to the front.
Amputation may be preferred in deformed & insensitive limb.
PERONEAL NERVE INJURY
• Injured by—
Rupture of LCL.
#, dislocation head of fibula.
By casts.
Crossing the legs.
C/F—
Significant pain.
Foot drop.
Loss of sensation over front & outer aspect of leg & dorsum of foot.
Treatment –
If there is division it is explored & repaired.
Foot drop splint is fitted.
Tendon transfer.
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