1. Prof Saleh WaslAllah Alharby www.ksu.edu.sa/DrSalehAlharby

2. 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

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

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

5. WHAT ARE THE FEATURES OF A PERIPHERAL NERVE? 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

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

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

8. 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

9. 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

10. 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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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