PERIPHERAL
NERVE
INJURIES
Classification of nerve injury
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.
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
Radial Nerve Injuries
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
Median Nerve Injuries
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
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.
 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
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
Sensory Loss
Claw Hand
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
Diagnostic tests
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EMG
SD curve
Nerve Conduction Studies
Tinel’s sign
Sweat test
Skin resistance test
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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
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)