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peripheral nerve lesions
- 1. PERIPHERAL NERVE INJURIES Dr. Mansoor Khan, MBBS, FCPS I, Resident Surgery, KTH, Peshawar
- 2. A N A T O M Y Connective tissue (epineurium, perineurium, endoneurium) Nerve tissue (axon, schwann cell)
- 4. A N A T O M Y EPINEURIUM PERINEURIUM ENDONEURIUM VESSELS
- 5. PERRIPHERAL NERVE INJUIES NERVE INJURIES Acute injury Chronic injury
- 6. N e u r o p r a x i a Mildest form, reversible conduction block (function loss), for hours or days due to direct mechanical compression, ischemia, mild burn trauma or stretch
- 7. A x o n t m e s i s Axonal and myelin sheath disruption while fascicular integrity is maintained--Wallerian degeneration occurs (prognosis is good—days, weeks)
- 8. N e u r o t m e s i s Laceration from sharp or blunt forces causing complete disruption of the axon and supporting connective tissue---very poor prognosis without surgical repair
- 11. C l i n i c a l S i g n s Motor function, Tinel’s sign (positive-sensory function negative (after 4-6weeks)-total interruption, Sweating-sympathetic fiber, Sensory function
- 12. Muscle atrophy start : post-injury 1 month peak : 3rd - 4th month
- 13. C h r o n i c N e r v e E n t r a p m e n t Paresthesia Loss of function Pain
- 14. P a t h o p h y s i o l o g y Direct compression Segmental demyelination Wallerian degeneration(distal) Ischemia Swelling of nerve Microcompartment SD
- 16. C a r p a l T u n n e l S y n d r o m e
- 18. PAIN & PARASTHESIA DISTRIBUSION
- 19. RELEASE SURGERY
- 21. SUPRA-CONDYLAR FRACTURE anterior displacement M E D I A N N E R V E
- 22. Radial Nerve Entrapment Posterior Interosseous Nerve Syndrome
- 23. Radial Nerve Entrapment Posterior Interosseous Nerve Syndrome
- 24. RADIAL NERVE INJURY Fracture of shaft of humrus
- 25. RADIAL NERVE INJURY WRIST DROP
- 26. GUYON’S CANNAL SYNDROME U L N A R N E R V E
- 27. CUBITAL TUNNEL SYNDROME U L N A R N E R V E
- 28. CUBITAL TUNNEL SYNDROME U L N A R N E R V E
- 29. Benediction posture CLAWING OF RING & LITTLE FINGER U L N A R N E R V E
- 30. FROMENT’S SIGN Flexior pollicus longus (median nerve) compensates for a weak adductor pollicis (ulnar nerve) U L N A R N E R V E
- 31. CUBITAL TUNNEL SYNDROME Ulnar nerve Release surgery U L N A R N E R V E
- 32. COMMON PERONEAL Fracture of the head of fibula
- 33. PERONEAL NERVE INJURY SYMPTOMS Decreased sensation, Slapping gait, foot drop, toes drag
- 34. FACIAL NERVE Anatomy
- 35. FACIAL NERVE Anatomy
- 36. FACIAL NERVE PALSY LOSS OF FRONING, DROOPING, EYEBROW DROP
- 37. C o n s e r v a t i v e t r e a t m e n t Indications Short history, mild-moderate, intermittent, reversible cause (pregnancy, oral contraceptive, endocrine abnormalities, type writer) Method Non-steroidal anti-inflammatory drugs, splint
- 38. T r e a t m e n t Time of operation Open injury Closed injury Early intervention Delayed intervention Delayed intervention
- 39. S u r g i c a l I n d i c a t i o n s Failed conservative treatment Severe injury (sensory loss, muscle atrophy, motor weakness)
- 40. E p i n e u r a l R e p a i r
- 41. F a s c i c u l a r R e p a i r
- 42. N e r v e G r a f t