Nerve Injuries

Kamrani R Sh MD.

Orthopaedic surgeon Hand surgeon General practitionare refreshment congress 7 11 86

Nerve injuries Compressive neuropathies

Injury

Sharp, penetrating, open wound Blount, close,  Laceration, Contusion, Tractional injury

Anatomy Pathology

Nerve injury

Nerve laceration

Tinel sign

Nerve injury  Classification  1-Seddon Neuroparexia Axonothemesis Neurothemesis  2-Sunderland

 2-Sunderland I type path II III IV V physio logic Axon tinel - / +/P Endon +/P Perin Epin +/Np +/Np Improve Complete instant Complete 1mm/d Incomp.

1mm/d No No

Penetrating wound  Diagnosis  Management  Treatment

 Diagnosis Sensory test Motor test Autonomus system test Deformity Tinel sign

Sensory test   Two point discrimination Autonomous zone  Symmetrical

Motor test   Specific muscles Trics   Gravity Biceps Synergic muscles Radial n.

Tenodesis

Sympatic system   Sweating Wrinkling  Immersing test

Tinel sign

Deformity

 Management

 Treatment

Prognosis  Sharpness  Age  Level  Specific nerve  Concomitant injury  Substance defect  Technique of repair

Sharp injury

Age

level

Specific nerve

Concomitant injury

Substance defect

Technique of repair

Blount trauma  Diagnosis  Mangement  Treatment

 Diagnosis Physical examination   Sensory & Motor tests Tinel sign Electrodiagnostic study  EMG  NCV Follow up

 2-Sunderland I type path II III IV V physio logic Axon tinel - / +/P Endon +/P Perin Epin +/Np +/Np Improve Complete instant Complete 1mm/d Incomp.

1mm/d No No

 Management & Treatment Early exploration Observation Nerve repair Nerve graft

Humerus bone Radial n.

Compressive neuropathy  CTS  Tardy Ulnar Nerve Palsy  Radial tunnel syndrome  etc

Summary

Neuroparexia with rapid recovery Axonothemesis, regeneration 1 mm/d of the nerve Physical examination  Bilateral sensory exam  Specific muscle function evaluation

Surgical exploration any penetrating wound Microscopically repair

Tardy ulnar nerve palsy