1. PERIPHERAL NERVE INJURIES

2. Classification of nerve injury

3. WALLERIAN DEGENERATION
The degenerative changes the distal segment of a peripheral nerve fiber (axon and myelin) undergoes,
REGERNERATION
Regrowth of the axon will take place down the endoneurial tube.
Regeneration of the axon will grow at the rate of 1-2 mm/day.

4. AXILLARY NERVE (C5 – C6)INJURY
Loss of deltoid contour and greater tuberosity prominent.
Clinical features: inability to abduct the arm because of the paralysis of the deltoid and teres minor.
Muscle wasting, can be observed by the loss in contour over the shoulder.
Sensory loss is minimal and seen in the lower half of the muscle

5. Radial Nerve Injuries Wrist Drop
Injuries to the Radial Nerve in the Axilla: In the axilla-
Crutch palsy,
Saturday night palsy
It can also be badly damaged in the axilla by fractures and dislocations of the proximal end of the humerus. Motor
The triceps, the anconeus, and the long extensors of the wrist are paralyzed.
The patient is unable to extend the elbow joint, the wrist joint, and the fingers.
Deformity : Wristdrop
Wrist Drop

6. Injuries to the Median Nerve at the Wrist
Median Nerve Injuries
Injuries to the Median Nerve at the Wrist
Motor: The thumb is laterally rotated and adducted. The hand looks flattened and “ape-like.”
Opposition movement of the thumb is impossible. The first two lumbricals are paralyzed,
Ape thump deformity

7. Carpal Tunnel Syndrome
it is an entrapment neuropathy caused by compression of median nerve in the carpal tunnel, in middle aged women .
cause is idiopathic in most patients
clinical features
. pain , numbness , tingling or an " electric shock " feeling in thumbs and finger supplied by the median nerve.

8. The condition is usually bilaterally
sometimes sensory loss of radial three and half digits
weakness and wasting of abductor pollicis brevis
Tinel's sign : tapping on the carpal tunnel produces pain
Diagnosis
diagnosis is clinical confirmed by nerve conduction velocity (NCV) that shows slowing of conduction over the wrist
Management :
1. Rest
2. Splinting at night
3. Local injection of corticosteroid
4. IF pregnancy is the cause - give diuretics
6.Surgical decompression of the nerve in carpal tunnel if all above measures fail

9. Ulnar Nerve (C8, T1) Injuries
Muscles paralyzed – Flexor carpi ulnaris, Hypo thenar muscles and Adductor pollicis
Sensory loss – Medial 1 ½ fingers
Deformity – Claw hand
Claw Hand
Sensory Loss

10. Common Peroneal Nerve Injury
Muscles paralyzed – Ankle Dorsiflexors and Foot Evertors.
Sensory loss – Loss of sensation occurs down the anterior and lateral sides of the leg and dorsum of the foot and toes
Deformity – Foot drop (Plantar flexion of Ankle and Inversion of foot)
Gait : Foot drop gait ( In adequate foot clearance during swing phase, so the patient compensates with excessive Hip flexion. So it is also called High stepping gait)
Foot Drop or High Stepping Gait

11. Diagnostic tests EMG SD curve Nerve Conduction Studies Tinel’s sign
Sweat test
Skin resistance test

12. Principles of treatment
To prevent or reduce oedema
Positioning,
Active movements,
Massage,
To prevent contractures
Passive movements to full joint ROM
Splints.
To maintain activity and power of unaffected muscles
Facilitate movement by supporting limb or functional splinting
Electrical stimulation by Interrupted Direct Current (IDC)
Encourage use of unaffected muscles in the limb
To look after areas where there is any sensory disturbance
Care for areas of anaesthesia

13. Splints Knuckle Bender Splint for Claw Hand (Ulnar Nerve)
Cockup Splint for Wrist Drop
(Radial Nerve)
Ankle Foot Orthosis for Foot Drop
(Common Peroneal Nerve)